THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 
LOS  ANGELES 


THE    EYE 

IN 

ITS  RELATION  TO  HEALTH 


THE  EYE 


IN 


ITS  RELATION  TO  HEALTH 


CHALMER   PRENTICE.  M.D. 


CHICAGO 

A.  C.  McCLURG  AND  COMPANY 

1895 


COPYRIGHT 
By  a.  C.  McCLURG  AND  CO. 

A.  D.    1895 


\^JU) 


NEW   THEORIES    THAT   ARE   TRUE,    MEET   ALL   THEIR 
OPPOSITION   FROM   THOSE   WHO    MISUNDERSTAND   THEM 


THE  EYE 


IN 


ITS    RELATION  TO   HEALTH 


I. 

A  CRITIC  is  one  who  is  skilled  in  judging  of 
the  merits  of  a  work.  He  must  be  a  con- 
noisseur ;  he  must  be  an  adept,  before  he  is  able 
to  pass  judgment  of  high  value. 

In  this  work  many  ideas  are  set  forth  that  are 
entirely  new.  Many  tests  are  suggested  that 
may  seem  strange,  and  results  recorded  that 
appear  incredible,  but  the  value  of  these  tests  can 
not  be  determined  without  thorough  investiga- 
tion. Viewed  from  the  standpoint  of  our  earlier 
professional  teaching  and  experience,  the  position 
I  assume  may  seem  to  be  wrong;  yet  careful  in- 
vestigation as  directed  in  this  work  will  perhaps 
prove  that  new  methods  will  produce  new  results. 
Some  months  or  even  a  year  and  more  ought  to 
be  spent  in  the  experiments  suggested  in  this 
work,  for  many  of  the  changes  sought  are,  at  the 
best,  slow,  and  the  conditions  with  which  we  deal 
are  at  times  obstinate  and  deceptive. 

After  investigation,  I  invite  criticism.  "Truth 
7 


8  THE  EYE  IN  ITS 

is  mighty  and  will  prevail."  This  is  the  one  sus- 
taining thought  to  one  who  presents  anything 
new  to  the  world;  and  for  appreciative  and  valu- 
able criticism  of  this  work  I  turn  to  those  only 
who  are  possessed  of  careful,  discriminating, 
strong,  individual  judgment,  and  whose  conclu- 
sions are  always  based  on  a  thorough  investiga- 
tion of  facts. 

However  extensive  the  experience  of  any 
oculist  may  have  been,  I  do  not  expect  from  him 
full  concurrence  in  my  opinions  as  a  result  of 
that  experience ;  and  any  judgment  from  that 
plane  I  shall  deem  in  a  great  measure  unfair ;  but 
from  such  a  source,  after  careful  consideration  of 
the  methods  I  have  suggested,  I  do  expect  con- 
currence, or,  at  least,  fair  criticism. 

A  perfect  judgment  can  not  be  fairly  arrived 
at  by  reading  only  a  part  of  this  work,  for  ques- 
tions might  suggest  themselves  on  one  page  which 
would  be  satisfactorily  answered  by  a  continuous 
and  careful  perusal  of  all  the  pages. 

A  subject  like  the  present,  pointing  toward 
advancement  in  the  field  of  medicine,  is  too 
sacred  to  be  trifled  with  by  casual  and  inexperi- 
enced criticism  ;  but  all  honest  inquiry  regarding 
my  methods  I  will  cheerfully  answer,  hoping 
thereby  to  advance  medical  science. 

I  fully  realize  that  manv  of  the  following 
statements  may  seem  incredible;  but  they  can  all 


RELA  TION  TO  HEAL  TH.  9 

be  practically  demonstrated  by  carefully  con- 
ducted tests  in  any  suitable  clinic,  which  is  the 
only  place  in  which  to  decide  a  question  of  so 
important  a  nature.  Under  suitable  conditions, 
I  shall  be  pleased  to  make  these  tests  at  any  time. 
There  seems  to  be  little,  if  anything,  left  to 
discover  concerning  the  laws  of  refraction  in  their 
application  to  defective  vision.  Helmholtz,  Bon- 
ders, Landolt  and  many  others  seem  to  have 
solved  nearly  every  problem  in  matters  of  refrac- 
tion and  the  application  of  glasses  for  correction 
of  the  same.  Many  ingenious  methods  have 
found  their  way  into  use  for  determining,  both  by 
objective  and  subjective  examinations,  the  arti- 
ficial aids  to  produce  the  most  perfect  vision. 
The  acquisitions  in  this  field  are  the  result  of  many 
years  of  careful  investigation,  through  all  of  which 
the  tacit  assumption  has  been,  that,  when  the  eye 
was  so  corrected  and  the  function  of  vision  at 
once  more  easily  and  perfectly  performed,  all  that 
could  be  desired  had  been  accomplished.  Here 
is  exactly  where  the  greatest  error  has  existed ; 
and  it  has  lain  so  deeply  hidden  that  it  is  not  en- 
tirely strange  that  it  has  remained  so  long  undis- 
covered. What  misled  us  to  the  greatest  extent 
was  that,  when  the  function  of  vision  was  perfectly 
performed,  we  rested  in  the  belief  that  the  eye  was 
perfect ;  but  it  did  not  occur  to  us  that  some  eyes 
might  be  using  an  excessive  amount  of   nerve- 


lo  THE  EYE  IN  ITS 

impulse  to  bring  about  and  sustain  that  perfect 
vision. 

Long  years  of  effort  are  made  by  defective 
eyes  to  perform  the  function  of  vision  as  perfectly 
as  possible.  When  necessary,  the  nerve-centers 
innervate  to  their  utmost  power  the  various  eye 
muscles,  causing  a  change  of  shape  in  the  crys- 
talline lens,  stretching  muscles  which  were  too 
short  and  shortening  muscles  which  were  too 
long,  to  enable  the  eyes  to  look  in  the  same 
direction.  These  conditions  are  continued,  and 
more  or  less  sustained,  from  day  to  day  through  a 
period  of  many  years.  Thus,  anatomical  parts 
that  were  manifestly  imperfect  at  birth  meet 
with  changes  in  shape  that  become  more  or  less 
established,  so  that  it  is  impossible  at  once  to 
discover  and  correct  the  same  by  fitting  such 
glasses  as  produce  the  most  perfect  vision.  Such 
a  procedure  is  often  incorrect,  inasmuch  as  it 
stimulates  the  maintainance  of  abnormal  condi- 
tions that,  as  soon  as  possible,  ought  to  be  dis- 
covered and  corrected.  When  all  the  facts  are 
carefully  considered,  we  can  readily  see  that  we 
may  have  more  or  less  firmly  fixed  conditions, 
which  will  only  recede  gradually  and  thus  permit 
the  eye  slowly  to  assume  a  normal  state. 

In  a  slight  measure,  the  discovery  of  the  ac- 
tion of  atropine,  hyoscyamine,  and  similar  drugs 
on  the   eye,  has  taught  us  that  the  first  manifest 


RELATION  TO  HEALTH.  n 

conditions  that  present  themselves  to  us  in  latent 
hypermetropia  are  not  what  they  seem.  For  in- 
stance, a  spasm  in  the  ciliary  muscle  often  hides 
a  great  measure  of  the  defect,  making  the  eye 
appear  more  perfect  than  it  really  is.  Similar 
hiding  power  may  exist  in  any  of  the  other  ocular 
muscles  and  deceive  us  as  to  their  true  conditions. 
It  is  for  this  reason  that  many  people  experience 
great  and  repeated  trouble  in  their  endeavors  to 
have  their  vision  properly  corrected.  They  pass 
on  and  on  from  one  professional  man  to  another, 
receiving  from  each  a  correction  that  proves  but 
temporary  ;  and  yet  it  is  probable  that  each  cor- 
rection was  made  scientifically  and  fulfilled  all 
needs  that  the  eyes  manifested  at  the  time  of  each 
examination.  Every  oculist  has  had  his  trouble- 
some cases  of  this  kind. 

The  reason  why  greater  uniformity  of  opinion 
has  not  existed  concerning  treatment  through  the 
sight  centers,  is  that  our  observations  have  been 
confined  to  more  or  less  manifest  defects,  and 
these  at  best  represent  but  a  very  small  percent- 
age of  the  disturbing  conditions  that  may  exist  in 
the  ocular  apparatus.  Defective  eye  muscles, 
which  tend  to  cause  the  eyes  to  deviate  from  a 
normal  position,  were  tested  by  various  methods 
tending  to  destroy  the  fusion  stimulus  ;  but  these 
methods  discover  only  a  very  small  percentage  of 
the  existing  abnormal  conditions.     The  great  ma- 


12  THE  EYE  IN  ITS 

jority  of  disturbing  causes  are  not  to  be  found  in 
manifest  defects  of  muscle  balance.  Some  of  the 
most  serious  conditions  exist  where  the  muscle 
balance  is  apparently  perfect,  the  defect  being  a 
fixed  abnormal  innervation  which  is  sustaining  a 
perfect  position  of  the  eyes,  and  which  continues 
to  maintain  it  under  all  tests  that  rely  on  the 
artificial  disturbance  of  fusion  power  (diffusion 
tests). 

Further  than  this,  in  a  large  share  of  those 
cases  where  the  deviations  are  manifest,  the  eyes 
are  turned  in  exactly  the  opposite  direction  to 
that  in  which  anatomically  short  muscles  would 
turn  them.  For  instance,  a  right  eye  with  a  short 
superior  muscle,  instead  of  being  drawn  upward, 
might  tend  downward  to  a  considerable  extent  by 
the  force  of  spasm.  The  nerve-impulse  sent  to 
the  inferior  muscle  to  enable  it  to  hold  the  eye 
down  level  with  its  fellow,  becomes,  through  re- 
sulting irritation,  more  than  is  necessary,  and  pulls 
the  eye  down  beyond  a  balance  ;  so  that  the  op- 
posite eye  will  be  the  higher  of  the  two  under  the 
diffusion  test,  because  the  abnormal  impulse  is 
permanent.  It  can  readily  be  seen  that  the  usual 
correction  of  an  eye  manifesting  this  reverse  con- 
dition would  prove  injurious  instead  of  beneficial. 
I  have  spoken  at  length  elsewhere  on  this  class 
of  cases  ;  adverse  results  in  them  are  strong  rea- 
sons why  we  have  not  attained  a  more  general 


RELATION  TO  HEALTH.  13 

success.  Such  results  have  failed  to  make  the 
treatment  impressive,  and  from  the  very  nature  of 
these  cases  as  set  forth  in  this  work,  it  will  be  seen 
how  unreliable  any  and  all  of  such  tests  are, 
however  complete  and  perfect  their  destruction  of 
fusion  power  may  be. 

Again,  eyes  that  are  capable  of  prominently 
manifesting  their  defects  are  more  or  less  at  rest 
when  not  in  constant  use,  whereas  absolutely  la- 
tent eye  troubles  find  no  such  periods  of  relief.  It 
is  from  the  latter  and  the  reverse  class  that  the 
most  serious  nervous  disturbances  take  their  rise. 
The  correction  of  muscular  insufficiency  or  man- 
ifest irregularity  must  not  be  confounded  with  the 
idea  of  repressing  abnormal  innervation.  One 
is  not  a  modification  of  the  other,  nor  do  they 
bear  the  slightest  resemblance  to  each  other, 
though  both  methods  of  treatment  are  through 
the  medium  of  the  eyes  ;  and  it  would  be  as  fool- 
ish to  confound  them  with  each  other  for  this 
reason  as  it  would  be  to  confound  various  schools 
of  medicine  because  the  remedies  are  applied 
through  the  medium  of  the  mouth. 

Eye-strain,  or  excessive  abnormal  innervation 
of  the  eye  muscles,  depletes  the  nerve-centers. 
It  also  gives  rise  to  brain  irritation  of  varying 
degrees.  Dispositions  are  altered  by  it ;  char- 
acter is  forcibly  changed ;  mental  faculties  are 
impelled  into  channels  of  work  that  are  anoma- 


H  THE  EYE  IN  ITS 

lous.  Into  such  an  altered  state  these  conditions 
may  force  a  being  as  to  make  him  appear  to  the 
world  an  entirely  different  character  from  what 
he  otherwise  would  have  been.  So,  if  in  time 
these  disturbing  conditions  can  be  corrected,  we 
may  expect  to  see  favorable  changes  in  the 
physical,  mental  and  moral  parts  of  the  indi- 
vidual. 

Some  very  remarkable  cures  have  followed 
the  correction  of  defects  in  and  about  the  eyes ; 
in  fact,  so  wonderful  have  some  of  these  changes 
been,  that  to  the  novice  it  seemed  absolutely  in- 
credible that  anything  in  connection  with  the  eye 
could  have  been  the  real  cause  of  the  change;  and, 
naturally,  he  turned  in  some  other  direction  to 
account  for  the  facts  which  were  too  stubborn  to 
be  denied.  Generally  what  is  called  "mental- 
suggestion,"  in  some  of  its  forms,  has  been  settled 
upon  as  the  cause  of  these  changes.  Some  per- 
sons have  more  or  less  belief  in  the  efficacy  of 
suggestion,  or  they  would  not  turn  to  it  as  such  a 
potent  cause ;  but  suggestion  as  a  curative  power 
has  been  known  under  various  names  for  ages. 
Gasner,  a  priest  of  Bavaria,  was  said  to  have 
worked  some  remarkable  cures  by  laying  on  of 
hands.  Hell,  of  Austria,  claimed  a  wonderful 
healing  potency  in  the  magnet.  Mesmer  took 
his  cue  from  the  preceding  claimant,  and  evolved 
what  has  been  known  for  a  century  as  mesmer- 


RELATION  TO  HEALTH.  15 

ism.  About  the  close  of  the  last  century,  the 
French  Academy  appointed  a  commission  to  in- 
vestigate the  principles  involved  in  Mesmer's 
work.  Benjamin  Franklin  was  a  member  of  that 
commission.  The  decision  arrived  at  was,  that 
whatever  effects  were  produced  were  of  a  tempor- 
ary character,  and  due  entirely  to  suggestion. 
Hypnotism  and  braidism  are  simply  other  names 
for  practically  the  same  influence.  There  are 
other  methods  of  more  modern  birth  that  owe 
whatever  efficacy  they  possess  to  suggestion.  I 
think  all  careful  observers  are  ready  to  admit 
that  there  is  considerable  influence  in  suggestion, 
both  for  good  and  for  evil,  especially  on  weak, 
nervous  people.  The  evil  effect  will  prove  the 
greater  and  more  lasting  of  the  two. 

However  potent  suggestion  may  be,  it  has 
never  been  an  aid  to  curative  results  through  the 
medium  of  the  eye ;  on  the  contrary,  it  has  been 
the  most  detrimental  element  in  the  way  of  its 
advancement.  Suggestion  is  more  effective  in 
the  shape  of  ridicule  than  any  other  form  of  its 
administration,  for  it  is  easier  to  depress  than  to 
elevate  a  failing  life  ;  and  such  we  have  frequently 
seen  sacrificed  to  the  potent  evil  influence  of  sug- 
gestion. The  strongest  evidence  of  the  true  value 
of  treatment  through  the  eye  is  the  fact  that 
it  has  made  all  of  its  advancement  through  a 
storm  of  opposition  and  ridicule,  the  only  argu- 


i6  THE  EYE  IN  ITS 

merits  of  the  unenlightened.  Suggestion  cannot  be 
said  to  have  had  any  influence  in  lunacy  and  other 
states  of  lost  minds  that  have  been  influenced  and 
restored  by  eye  treatment.  Prisms  in  a  certain 
position  often  relieve  pain,  and  when  reversed  in- 
crease it ;  yet  the  suggestion  is  equally  potent  in 
either  position. 

It  is  common  and  natural  to  cling  to  a  belief 
in  things  and  methods  that  have  long  been  estab- 
lished, and  in  which  leading  men  and  authors 
concur;  and,  if  the  results  of  such  following  are 
universally  perfect,  more  cannot  be  desired.  But, 
when  they  fall  far  short  of  satisfaction,  we  are 
warranted  and  even  impelled  to  search  outside  of 
established  authority  for  the  aid  that  it  fails  to 
give ;  otherwise,  science  and  art  would  never 
advance. 


RELATION  TO  HEALTH.  I? 


11. 


NO  part  of  the  living  body  is  constructed  in 
vain.  Every  minute  portion  has  some  par- 
ticular office  to  perform.  However  simple  or  how- 
ever complex  any  one  of  these  parts  may  be,  it  is 
so  constructed  as  to  facilitate  the  work  that  it  has 
to  do.  Each  distinct  part  may  be  looked  upon  as  a 
little  engine  which  is  put  in  motion  by  the  appli- 
cation of  the  motive-force  that  enables  it  to  per- 
form its  function.  This  motive-force  is  conveyed 
from  the  place  where  it  is  generated,  through 
conductors  called  nerves,  to  the  part  where  the 
function  is  performed;  and,  like  the  running  of  an 
ordinary  engine,  the  character  of  the  function  is 
determined  by  the  character  of  the  motive-force 
supply.  If  the  proper  amount  of  steam  is  admit- 
ted to  perform  the  function  of  the  engine,  the 
work  is  properly  and  evenly  done.  If  too  much 
steam  is  turned  on,  the  engine  runs  too  rapidly 
and  is  likely  to  do  itself  injury  by  over-work.  If 
too  little  is  applied,  the  running  of  the  engine  is 
very  feeble  and  can  be  stopped  by  the  slightest 
interference.  If  the  steam  is  cut  off  entirel}-,  the 
engine  stops.  Here  we  have  a  perfect  analogy 
to  all  functions  in  the  human  or  animal  body.      If 


i8  THE  EYE  IN  ITS 

the  motive-force  is  just  adequate  to  the  necessi- 
ties of  the  part,  the  function  will  be  normal ;  but, 
if  the  motive-force  is  in  excess,  the  function  will 
be  erratic  and  unnatural,  exhibiting  disturbances 
which  will  be  classified  as  some  disease  of  the 
part,  which  will  be  of  an  active  nature.  If  the 
motive-force  is  lacking  in  quantity  and  regularity, 
the  result  will  be  that  the  function  will  be  very 
feebly  performed,  and  some  sluggish,  indolent 
condition  will  follow,  which  will  be  classified  as 
an  inactive,  indolent  disease.  These  changes, 
which  are  similar  in  all  parts,  can  be  easily  noted 
and  demonstrated  in  the  action  of  the  heart  In 
a  state  of  perfect  health,  the  nerve-centers  are 
furnishing  and  sending  to  this  little  engine, 
impulses  of  motive-force  which  give  rise  to  a  reg- 
ular, unvarying  beat  of  about  seventy  impulses  to 
the  minute.  Now,  if  the  nerve-centers  be  excited 
in  any  way,  the  heart's  action  at  once  will  mani- 
fest the  change.  A  cry  of  fire,  a  terrific  explosion, 
or  the  sudden  consciousness  of  some  important 
news  of  good  or  bad  import,  causes  an  excitement 
of  the  nerve-centers  in  which  the  supply  of  nerve- 
force  is  temporarily  increased,  and  a  larger  amount 
than  usual  traverses  the  various  nerves  throughout 
the  entire  system.  The  heart's  action  becomes 
violent  and  rapid,  manifesting  the  exact  amount 
of  change  of  motive-supply  from  the  nerve-centers 
to  the  heart.     We  note  the  changes  of  action  par- 


RELATION  TO  HEALTH.  19 

ticularly  in  the  heart,  whereas  the  fact  is,  every 
function  in  the  whole  body  is  equally  affected, 
but  the  change  is  not  so  manifest  to  our  ob- 
servation ;  nevertheless,  the  alteration  of  function 
everywhere  in  the  body  is  equivalent  to  the 
change  in  the  motive-force  supply.  The  nature 
of  the  function,  whether  it  be  normal  or  erratic, 
is  a  manifestation  of  the  character  of  the  motive- 
force  supply,  really  giving  us  a  perfect  idea  of  the 
condition  of  the  nerve-centers  from  which  the 
force  is  proceeding.  This  would  naturally  lead  us 
to  the  conclusion  that  all  alterations  of  func- 
tion ARE  PRIMARILY  CENTRAL  IN  THE  NERVOUS 
SYSTEM. 

Every  organ  in  the  body  has  special  organic 
work  to  perform.  Likewise,  the  various  tissues 
of  which  the  organ  is  constructed  have  functions 
to  perform.  Every  little  living  cell,  be  it  bone, 
nerve,  muscle  or  any  tissue,  has  a  function  to  per- 
form called  assimilation.  A  cell  of  adipose  or 
fat  possesses  the  power  to  attract  to  itself  carbon, 
hydrogen,  and  oxygen,  or  matter  of  its  own  kind, 
in  just  the  proportions  of  which  the  cell  is  com- 
posed, and  in  quantity  just  sufficient  to  maintain 
the  proper  size  of  the  cell :  surrounding  the  cell 
is  the  cell  wall  structure,  which  is  doing  a  separate 
work  by  drawing  to  itself  matter  of  its  own  kind, 
but  in  different  proportions  to  the  cell  within  : 
again,  adjacent  to  this  is  a  cell  of  muscle,  bone, 


20  THE  EYE  IN  ITS 

periosteum  or  other  structure,  each  attracting  dif- 
ferently unto  itself  elements  of  its  own  kind,  in 
just  the  proportions  that  each  needs  :  and  so  on 
throughout  all  the  various  structures  of  the  animal 
economy.     These  are  all  separate  little  functions. 

The  blood  is  simply  a  carrier  of  the  food 
from  which  all  the  elements  of  the  body  derive 
their  sustenance ;  but  it  does  not  perform  the 
multiple  function  to  select,  for  the  many  cells  of 
various  kinds,  their  individual  complex  require- 
ments. Each  individual  cell  possesses  the  power 
to  select  by  its  polar  forces  that  which  it  requires; 
and  these  forces  are  generated  and  sustained  by 
nerve-impulse. 

Each  separate  and  individual  part  or  organ  of 
the  animal  economy  has  some  special  place  or 
center  in  the  nervous  system  that  presides  over  it; 
some  specific  center  where  is  generated  the 
motive-force  that  performs  the  function  of  the 
part  over  which  it  has  control ;  and  the  manner  in 
which  the  part  does  its  work  determines  for  us 
the  condition  of  its  motive  center.  A  very  few 
of  these  nerve-centers  have  been  located ;  yet  a 
sufficient  number  to  assure  us  that  each  function 
has,  somewhere  in  the  nerve-centers,  a  special 
place  that  is  generating  and  sending  forth  that 
force  which  does  the  work. 

We  may  look  upon  the  brain  as  a  series  of 
dynamos  that  are  constantly  generating  motive- 


RELATION  TO  HEALTH. 


21 


force,  and  sending  it  out  over  the  various  con- 
ductors that  we  call  nerves,  which  convey  it  to 
the  place  where  the  work  is  done.  This  force 
polarizes  the  cell  structure,  which  then  performs  the 
work  of  attraction  and  repulsion. 


1.  Visual  centers.  5.  Complicated  movements  of  hand, 

2.  Taste,   smell    and    sexual    feeling  arm  and  leg. 

(centrally  located).  6.  Coarse  leg  movements. 

3.  Hearing.  7.  Coarse  arm  and  leg  movements. 

4.  Face,  tongue  and  speech.  8.  Coarse  arm  movements. 

9.  Writing  images. 

When  the  liver,  kidneys,  heart  and  other 
organs  continue  to  perform  their  various  offices  in 
a  healthy  manner,  the  inference  is  that  the  motive- 
forces  are  being  furnished  accordingly ;  but, 
whenever  any  of  these  organs  begin  to  perform 
unnatural  offices — generating  abnormal  secretions 
such  as  sugar,  uric  acid,  etc. — we  infer  that  abnor- 
mal motive  impulses  have  supervened. 

Normal  secretions  are  the  outcome  of  nor- 
mal FUNCTIONS    PERFORMED   BY   NORMAL    IMPULSES. 

Abnormal  secretions  are  the  outcome  of 


22  THE  EYE  IN  ITS 

ABNORMAL     FUN'CTIONS     PERFORMED     BY     ABNORMAL 
IMPULSES. 

Each  class  of  secretions  is  dependent  on  its 
characteristic  motive-force.  In  other  words, 
when  a  function  becomes  abnormal,  it  is  not  the 
part  or  engine  that  is  at  fault,  it  is  always  the 
motive-impulse  which  is  responsible  for  the 
erratic  work.  For,  even  if  the  part  itself  through 
local  irritation  or  injury,  is  caused  to  change  its 
action,  it  even  then  does  it  by  first  sending  the 
irritation  to  the  presiding  nerve-center,  which 
reflects  the  impulse  that  causes  the  change. 

When  a  bone  is  broken,  the  first  natural,  local 
changes  that  follow  are  pain  and  inflammation, 
which  occur  as  follows  :  From  the  point  of  irri- 
tation caused  by  the  fracture,  an  impulse  is  sent 
to  the  nerve-centers  that  preside  over  the  part. 
They  return  their  characteristic  impulses  to  the 
place  of  injury,  which  at  once  establishes  an 
inflammatory  action  at  the  place  of  rupture ;  and 
this  action  involves  the  manufacture  or  formation 
of  those  products  or  elements  needed  to  repair  or 
heal  the  part.  These  are  new,  temporary  func- 
tions. Without  this  communication  from  the 
injury  to  the  nerve-centers  and  the  corresponding 
return  current,  the  fractured  ends  would  never 
become  reunited  nor  the  injury  repaired. 

I  have  in  mind  a  case  of  a  railroad  employe 
who  was  under  my  care  some  twenty-five  years 


RELATION  TO  HEALTH.  23 

ago.  Both  bones  in  the  lower  part  of  the  leg 
were  broken  and  protruded  through  the  skin.  The 
fractured  ends  were  properly  adjusted.  In  a  gen- 
eral way,  he  was  an  unhealthy  man,  with  a  very 
weak  nervous  system.  After  several  days,  the 
patient  remarked  to  me,  "I  think  you  are  a  very 
good  doctor  for  I  have  no  pain  in  my  leg."  I 
said,  "My  dear  fellow,  that  is  just  what  does  not 
suit  me.  I  prefer  that  you  should  have  some 
pain  and  inflammation."  But  it  did  not  follow. 
For  one  hundred  and  forty  days,  I  tried  all  the 
various  methods  known  to  get  up  an  irritation  in 
the  part,  after  which  I  first  discovered  symptoms 
of  the  broken  ends  reuniting  themselves.  In  this 
case,  the  delay  resulted  from  the  weak  condition 
of  the  nerve-centers  and  their  inability  to  respond 
by  sending  back  to  the  injured  part  the  proper 
nerve-impulse  to  establish  the  inflammatory  ac- 
tion of  repair.  Never  can  work  or  function  be 
performed  without  the  appropriate  application  of 
some  motive-force  to  perform  it. 

However  brilliant  an  inventive  genius  may  be 
in  all  other  directions,  he  begins  to  lose  his  reason 
when  he  searches  after  perpetual  motion,  or  a 
piece  of  machinery  so  constructed  as  to  possess 
in  itself  the  power  to  do  the  work  or  perform  the 
function.  Such  an  unfortunate  genius  generally 
ends  his  life  in  a  lunatic  asylum.  As  in  mechanics, 
so  in  animal  life,  all  effects  have  a  cause. 


34  THE  EYE  IN  ITS 


III. 


SIGHT  is  not  passive,  it  is  an  active  function; 
and,  although  we  see  apparently  without 
effort  and  without  volition,  yet  every  moment  of 
vision  is  costing  its  adequate  amount  of  vital 
energy.  True,  we  cannot  say  just  how  much 
energy  is  utilized  in  looking  any  given  length  of 
lime  at  any  particular  scene  ;  but  we  do  know  that 
many  nervous  persons  are  very  much  exhausted  by 
the  use  of  the  eyes  for  a  short  time  in  an  art  gal- 
lery, where  things  of  great  interest  are  constantly 
attracting  their  attention.  Some  are  more  ex- 
hausted by  one  hour  of  such  effort  with  the  eyes 
than  they  would  be  by  ten  hours  of  manual  labor; 
consequently  the  same  amount  of  vital  force  that 
would  be  required  for  ten  hours  of  labor,  may  be 
disposed  of  in  one  hour  through  the  medium  of 
the  eyes.  Now,  if  there  be  some  defect  in  the 
construction  of  the  eyes,  the  consumption  of 
nerve-force  will  be  much  greater  ;  for  example,  a 
short  superior  muscle  in  one  eye  requires  many 
times  the  amount  of  nerve-force  to  perform 
the  function  that  the  centers  were  ever  intended 
to  furnish.  The  function  of  sight  may  be  as  suc- 
cessfully performed  as  if  the  eyes  were  perfect, 


RELATION  TO  HEALTH.  25 

but  only  by  an  excessive  call  on  the  nerve-cen- 
ters to  maintain  a  balance  between  the  two  eyes  ; 
in  such  cases  the  vision  is  sometimes  of  more 
than  average  sharpness.  This  extravagant  waste 
might  find  a  good  parallel  in  the  following  :  An 
electric  plant  is  scientifically  constructed  for  the 
purpose  of  running  fifty  arc  lights  ;  each  light 
utilizes  a  given  amount  of  electric  force  that  is 
generated  at  the  electric  center,  and  the  fifty 
lights  just  use  up  what  force  the  dynamo  can 
easily  generate.  Now,  in  the  place  of  one 
of  these  arc  lights,  if  we  place  an  electric  motor 
which  uses  twenty  times  as  much  force  as  the 
light  that  it  has  displaced,  the  whole  electric  sys- 
tem will  be  disturbed,  from  the  fact  that  the  elec- 
tric motor  is  utilizing  more  than  its  share  of  the 
motive-force ;  consequently  the  other  forty-nine 
lights  in  the  circuit  will  ^  not  receive  enough  to 
perform  their  intended  functions  ;  they  will  sput- 
ter, burn  irregularly  and  feebly.  We  have  here 
a  state  of  affairs  in  our  arc  light  system  which 
may  be  likened  to  that  form  of  nervous  debility 
where  the  prominent  feature  is  constant  exhaus- 
tion, due  to  a  lack  of  sufficient  force  of  nerve- 
impulse.  But  in  the  animal  economy,  another 
condition  may  follow  when  the  "dynamo"  is 
over-taxed  ;  the  nerve-centers  may  be  excited  to 
an  irritable  condition  in  which  they  generate  an 
excessive    amount   of    nerve-force,    and   then  we 


26  THE  EYE  IN  ITS 

have  an  excited  or  agitated  form  of  nervous 
derangement ;  and,  whether  it  be  general  or  local- 
ized, it  soon  wears  out  life. 

Strictly  construed  the  terms  neurasthenia  and 
nervous  debility  mean  a  weak  or  depressed 
nerve-force  supply.  They  are  sometimes  care- 
lessly applied  (but  are  not  properly  applicable) 
to  all  nervous  derangements  ;  for  we  often  meet 
with  nervous  derangements  that  consist  of  an 
excessive  supply  of  nerve-force,  usually  accompa- 
nied with  more  or  less  irritability,  all  functions  in 
general  being  emphasized.  The  enormous  assim- 
ilation in  abnormally  fat  persons,  and  the  exces- 
sive muscular  development  and  activity  in  a  class 
of  phenomenal  athletes,  whose  histories  are  short 
and  generally  end  in  some  rapidly  wasting  dis- 
ease, are  extreme  examples  of  that  form  of  ner- 
vous derangement  which  consists  of  an  excess  of 
nerve-force  supply  and  which  should  be  called 
7ieurosthenia.  The  term  abnormal -innervation 
embraces  both  of  these  conditions. 

Our  fast  ocean  steamers  can  run  nineteen  or 
twenty  miles  an  hour  without  excessive  con- 
sumption of  fuel  ;  but  when  the  speed  is  raised 
to  its  highest  possibilities,  the  last  two,  three  or 
four  miles  are  attained  at  a  very  extravagant 
increase  in  the  fuel,  the  consumption  being  far 
greater  in  proportion  per  mile  as  well  as  resulting 
in  a  great  strain  throughout  the  ship.     A  ship  is 


RELATION  TO  HEALTH.  27 

sometimes  unable  to  sustain  the  highest  tension 
that  can  be  put  upon  her  by  her  engines,  in 
which  case  the  good  engineer  turns  off  the  excess 
or  abnormal  quantity  of  steam,  slows  her  speed 
to  an  easy  pace,  and  thus  her  life  in  the  waters 
is  lengthened  many  years.  Likewise  when  we 
learn  that  some  of  our  functions  are  being  per- 
formed at  an  abnormally  high  tension  requiring 
an  extravagant  amount  of  nerve-force  to  sustain 
them,  which  is  rapidly  wearing  us  out,  we  should 
suspend  this  high  rate  of  function  and  conserve 
as  far  as  possible  our  life  forces,  by  removing  the 
cause  of  the  irritation  and  waste. 

The  nerve-centers  are  capable  of  generating  a 
certain  amount  of  motive-force  or  nerve-impulse 
and  no  more.  Whenever  the  call  upon  the  cen- 
ters exceeds  their  ability  to  respond,  the  result  is 
a  disturbance  somewhere.  A  large  amount  of 
motive-force  is  utilized  in  the  function  of  vision 
even  when  it  is  performed  under  the  easiest 
possible  circumstances  ;  but  when  there  are  de- 
fects in  the  eye  and  its  appendages,  there  is  a 
still  greater  demand  for  nerve-force  to  bring 
about  good  vision. 

Each  nerve-center  is  intimately  connected  and 
in  delicate  sympathy,  with  all  other  centers  of 
the  nervous  system.  Any  radical  change  in  one 
center  sends  its  characteristic  influence  through- 
out all. 


28  THE  EYE  IN  ITS 

Harmonious  and  pleasant  sounds,  picturesque 
scenes  filled  with  things  of  beauty,  loveliness 
and  goodness,  have  the  most  marked  influence 
over  the  nerve-centers  in  general  and  manifest 
themselves  in  the  form  of  the  body,  the  grace  of 
movement  and  the  sweetness  of  expression  in 
the  features.  Such  external  influences  have  a 
tendency  to  produce,  through  the  medium  of 
vision,  the  perfect  man  and  woman  ;  whereas  the 
one  who  is  reared  amid  scenes  of  crime  and  bru- 
tality, coarseness  and  privation,  is  so  influenced 
in  his  whole  physical  being  that,  to  the  experi- 
enced eye,  their  marks  are  everywhere  to  be  seen. 

The  reason  husband  and  wife  grow  to  look 
alike  after  living  years  in  each  other's  company 
is,  that  they  have  looked  so  constantly  upon  each 
other's  features,  have  been  made  glad  by  the 
same  influences,  have  enjoyed  the  same  sunshine, 
have  met  with  the  same  sorrows  and  have  been 
so  often  subjected  to  the  same  experiences,  that 
their  functions  have  become  similar. 

Now  what  particular  portion  of  the  nerve- 
centers  should  we  expect  to  have  the  greatest 
influence  in  changing  and  controlling  the  general 
nervous  system?  Would  it  be  one  of  the  duller 
centers,  or  would  it  be  the  most  acute  and  sensi- 
tive? We  would  reasonably  look  to  the  most 
sensitive  as  bearing  the  highest  influence  both  for 
good  and  evil. 


RELATION  TO  HEALTH.  29 

Of  all  the  centers  in  the  nervous  system, 
which  is  the  most  sensitive,  the  most  highly  acute 
and  the  most  constantly  in  use? 

The  answer  is,  that  center  in  which  the  most 
positive  impression  is  made  by  the  lightest  and 
most  delicate  touch  or  impact.  Various  parts  of 
the  body,  for  instance,  the  fingers,  come  in  con- 
tact with  a  substance ;  immediately  there  is  an 
afferent  impulse  communicated  to  the  nerve-cen- 
ters that  says,  'this  is  velvet,  fur,  wood,  metal, 
hot  or  cold.'  Again,  substances  of  different 
flavors  are  taken  into  the  mouth.  When  they 
come  in  contact  with  the  nerves  of  taste  (gusta- 
tory nerves)  the  afferent  impulses  from  this  con- 
tact convey  to  the  nerve-centers  the  consciousness 
of  the  presence  of  lemon,  orange,  vanilla,  etc., 
and  the  reflex  of  swallowing  or  deglutition  fol- 
lows. If  the  flavor  be  something  which  conveys 
to  the  nerve-centers  a  disagreeable  or  nauseous 
taste,  the  opposite  reflex  follows,  and  an  effort  is 
made  to  reject  the  offensive  material  instead  of 
swallowing  it. 

The  auditory  center  discriminates  in  all  the 
delicate  sounds  known  to  music,  in  all  the  varieties 
of  harmony  and  discord.  The  potent  influence 
of  music  on  the  feelings  of  man  and  beast  is  well 
known. 

Another  sense  equally  or  more  delicate,  is  that 
of  smell.     The  perfumes  emanating  from  helio- 


30  THE  EYE  IN  ITS 

trope,  violet  and  other  flowers  can  neither  be 
weighed,  measured  nor  analyzed,  being  so  deli- 
cate and  imponderable ;  yet,  the  sense  of  smell 
produced  by  them  is  of  a  very  positive  nature. 

As  delicate  as  the  above  named  senses  are, 
there  is  yet  another  of  a  much  more  highly  acute 
nature ;  in  fact,  by  far  the  most  delicate  sense  of 
all,  sight. 

Light  is  imponderable ;  its  rays,  reflected 
from  various  objects,  pass  through  the  cornea, 
the  aqueous  humor,  the  crystalline  lens,  the  vit- 
reous body,  and  there  reach  the  retinal  nerves. 
The  delicacy  of  this  touch  or  impact  on  the 
retinal  nerves  is  beyond  the  conception  of  the 
human  mind ;  yet  it  establishes  from  this  point 
an  impulse  which  is  conveyed  to  the  visual  or 
sight  centers  of  the  brain,  which  with  no  uncer- 
tainty, determines  form,  color,  motion,  quantity, 
and  space.  Here  we  have  the  most  positive 
sense  or  feeling  known  to  man ;  sight,  produced 
by  an  impact  or  touch  of  the  most  imponderable 
agent  or  force  known  to  science.  There  is  not 
an  impression,  feeling  or  sense  with  which  the 
nerve-centers  have  ever  been  made  familiar  which 
is  not  in  some  measure  reawakened  through  the 
visual  apparatus. 

The  musician  runs  his  eye  over  the  page  of 
written  music,  and  he  hears  it.  One  sees  a  person 
across  the  street  eating  a  lemon,  and  he  tastes  it. 


RELATION  TO  HEALTH.  3^ 

The  salivary  glands  begin  to  act  ten  rods  away 
from  the  lemon.  We  see  a  person's  foot  run 
over  or  crushed,  and  we  feel  the  wound.  It 
produces  changes  throughout  the  observer's 
nervous  system,  nausea  results,  and  often  so 
forcible  is  the  effect  that  unconsciousness  follows. 
Through  this  medium,  mothers  have  communi- 
cated deformities  to  their  offspring  by  changes  in 
the  nerve-impulses  that  control  the  function  of 
construction  or  building.  There  are  many  sub- 
stances which  we  cannot  recognize  by  the  sense 
of  touch,  but  which  sight  determines  for  us  at 
once,  showing  that  the  visual  nerve-centers  are 
the  most  sensitive  of  all. 

It  is  through  the  feelings  awakened  by  sight 
that  in  reading  a  book  and  looking  at  its  illustra- 
tions, we  are  enabled  to  live  in  the  very  atmos- 
phere of  the  scene  that  is  depicted  and  to  drink 
and  satiate  ourselves  to  the  fullest  extent,  feeling, 
tasting,  smelling  and  hearing  the  various  things 
and  surroundings  that  the  author  suggests. 

If  the  light  of  a  single  candle  is  sufficient  to 
produce  a  perfect  impression  of  a  given  object  in 
the  visual  centers,  say  a  letter  A,  there  is  a  feeling 
produced  in  the  nerve-centers  that  tells  us  of  the 
presence  of  a  letter  A.  If  twice  the  light  that  is 
necessary  is  reflected  from  this  letter  A,  twice  the 
impact  or  impression  that  is  necessary  is  conveyed 
to  the  visual   centers   and    they   are   taxed  to  a 


32  THE  EYE  IN  ITS 

double  capacity.  Should  this  light  be  increased 
to  twenty  candle  power,  where  one  would  be 
sufficient,  the  visual  centers  will  receive  an 
impulse  twenty  times  as  strong  as  necessary  to 
produce  the  function  of  seeing  the  letter  A,  or 
whatever  object  the  eye  may  be  resting  upon,  and 
the  feeling  of  sight  is  over-taxed  and  disturbed  ; 
for  sight  is  nothing  more  or  less  than  feeling. 
This  excessive  amount  of  useless  work  even  in  a 
normal  eye  wears  on  these  delicate  centers 
beyond  necessity,  and  they  become  centers  of 
irritation  and  convey  disturbed  conditions  to 
other  parts  or  centers  of  the  nervous  system.  I 
touch  a  person  on  the  shoulder  gently ;  this  per- 
forms the  function  of  attracting  his  attention. 
Again,  if  I  were  to  use  a  club  and  strike  a  severe 
blow,  the  attention  would  be  attracted,  but  the 
force  of  the  impact  would  be  more  than  necessary 
and  an  injury  to  the  part  would  be  the  result. 
It  is  the  same  with  the  delicate  sight  centers. 
Just  a  sufficient  amount  of  light  to  perform  the 
function  is  all  that  is  required,  but  a  flood  of 
enough  force  can  be  admitted  to  practically 
bruise  these  delicate  parts  of  the  nervous  system. 
Since  the  advent  of  electric  lights  which  have 
practically  turned  night  into  day,  there  has  been 
an  increase  in  nervous  disturbances,  due  to  over- 
taxation of  the  visual  centers  of  the  nervous 
system.     We    turn    our    eves     in    the    direction 


RELATION  TO  HEALTH.  33 

of  hills,  valleys,  rivers  and  woods,  and  the 
light  reflected  from  the  various  objects 
passes  into  the  eye  and  touches  the  nerves  of 
sight.  From  here  an  impulse  is  conveyed  to  the 
sight  centers  of  the  brain  and  here  we  feel  the 
form,  size,  color  and  motion  of  the  various 
objects  in  the  scene. 

The  feeling  of  harmonious  sounds  in  the  audi- 
tory centers  is  enjoyable  for  the  space  of  two  or 
three  hours,  but  a  continuance  beyond  this  length 
of  time  becomes  tiresome,  and  the  same  sounds 
repeated  for  five  or  six  hours  would  be  annoying. 
These  centers  become  temporarily  exhausted  or 
worn  out. 

The  feeling  of  taste  when  eating  the  choicest 
delicacies,  in  a  short  time,  perhaps  an  hour, 
becomes  wearied,  temporarily  perverted,  and 
beyond  this  time  enjoyment  ceases.  The  gusta- 
tory centers  refuse  to  be  further  taxed. 

The  feeling  of  smell  through  the  olfactory 
centers  is  very  delightful  for  the  first  few  inhala- 
tions of  some  delicate  perfume ;  the  sense  of 
smell  is  at  first  prominent,  but  after  a  few 
moments  the  odor  seems  to  excite  no  feeling  at 
all.  Nothing  but  the  pungent  feeling  of  alcohol 
at  last  is  present.  From  over-work  the  olfactory 
centers  have  suspended  their  functions. 

The  feeling  in  the  visual  centers  commences 
at  seven  o'clock   in  the   morning  and   continues 
3 


34  THE  EYE  IN  ITS 

until  ten  o'clock  at  night.  For  fifteen  hours  con- 
tinuously, more  or  less,  the  feeling  in  the  visual 
centers  has  been  constant.  No  other  sense  in  the 
nerve-centers  is  capable  of  such  continued  endur- 
ance. 

For  good  or  for  evil,  according  to  their  char- 
acter, the  senses  of  feeling,  taste,  smell,  hearing 
and  sight  have  all  a  marked  influence  both  on  our 
mental  and  physical  lives.  Sounds  of  harmony, 
delicacies  of  wholesome  and  pleasant  taste,  odors 
that  delight  and  please  the  sense  of  smell,  and 
scenes  of  beauty,  all  have  an  elevating  influence 
over  our  mental  and  physical  lives  tending  to  a 
refinement  of  both  mind  and  body ;  while  the 
opposites  of  these  experiences  produce  an  un- 
favorable or  opposite  effect  throughout. 

"Why  was  the  Grecian  a  poet  and  philosopher, 
while  the  Scythian  was  a  wanderer  and  robber  ? 
One  was  reared  amid  surroundings  of  beauty  and 
culture,  the  other  had  a  barbarian  land,  rude  as 
his  manners  and  wild  as  his  heart. 

Again  I  repeat.  The  visual  centers  are  the 

MOST  SENSITIVE  AND  MOST  CONSTANTLY  TAXED,  BE- 
CAUSE THE  MOST  CONTINUOUS  AND  POSITIVE  FEELING 
IS  PRODUCED  BY  THE  IMPACT  OF  AN  IMPONDER- 
ABLE AGENT.  The  touch  of  only  a  subdued  ray 
of  light  gives  rise  to  a  feeling  which  is  the 
most  certain  and  continuous  of  all  functions  of 
feeling. 


RELATION  TO  HEALTH.  35 

As  to  the  anatomical  location  of  the  nerve- 
centers  generally,  it  will  have  to  be  a  matter  of 
speculation,  because  an  immense  amount  of  re- 
search prosecuted  by  able  men  has  located  only 
a  few  of  them.  Victor  Horsley  in  his  work 
on  "The  Brain  and  Spinal  Cord  "  says:  "Per- 
sonally, I  believe  that  anatomical  research  will 
do  less  than  physiology  toward  settling  these  im- 
portant and  most  difficult  questions,  and  that  as  a 
fact,  we  shall  not  advance  very  far  towards  their 
solution  until  we  are  able  to  approach  them  from 
the  standpoint  of  their  functions,  which  of  course 
is  a  totally  different  mode  of  comparative  invest- 
igation." Also,  "Anatomy  is  not  able  to  adduce 
absolute  evidence  either  as  to  agreement  or  disa- 
greement in  the  evolution  of  the  structure,  it  is 
likely  that  the  physiological  aspect  of  the  case  is 
the  more  correct  one." 

From  a  physiological  standpoint,  there  would 
appear  to  be  a  great  number  of  visual  centers  in 
the  nervous  system.  When  rays  of  light  are  re- 
flected from  an  object  and  focussed  in  each 
eye,  there  is  a  strong  effort  of  the  two  eyes  to  fix 
themselves  in  such  a  position  that  the  picture 
made  or  reflected  on  the  posterior  part  of  each 
eye  shall  be  in  corresponding  localities.  A  ray 
of  light  falling  exactl}^  on  the  most  sensitive  cen- 
ter or  yellow  spot  of  the  right  eye,  stimulates 
through  the  nerve-centers,  a  tendency  to  fix  the 


36  THE  EYE  IN  ITS 

left  eye  in  such  a  position  that  a  ray  of  light 
emanating  from  the  same  point  will  also  fall  upon 
the  most  sensitive  center  or  yellow  spot  in  that 
eye.  The  same  tendency  prevails  throughout 
the  field  of  vision.  If  an  eye  is  fixed  on  an  ob- 
ject, it  will  be  possible  to  see  other  objects  for 
quite  a  distance  in  various  directions  without 
moving  the  eye  ;  for  instance,  objects  upward  as 
far  as  45  deg.  can  be  seen,  outward  over  90  deg., 
downward  about  70  deg.,  inward  55  deg.  to  60 
deg.,  according  to  the  prominence  of  the  bridge 
of  the  nose.  To  define  an  object  as  having  form, 
it  is  necessary  that  several  impressions  be  re- 
ceived in  the  nerve-centers  simultaneously  or 
nearly  so.  The  average  acuity  of  vision  is  said 
to  be  an  angle  of  one  minute.  The  top  of  a  letter 
E  falls  on  a  portion  of  the  retina  that  conveys  an 
impression  of  its  existence,  also  the  tongue  of 
the  letter  and  the  bottom  of  it ;  the  upright 
portion  and  the  two  spaces  between  the  tongue 
and  the  upper  and  lower  parts,  fall  upon 
separate  portions  of  the  retina,  each  of  which 
takes  a  distinct  impression,  and  their  relative 
positions  are  noted  by  separate  and  distinct 
sensory  centers  in  the  brain ;  consequently  we 
feel  the  form  of  the  letter  E.  If  it  were  a  single 
sensory  center  that  these  distinct  and  separate 
objects  were  conveyed  to,  it  would  be  a  single 
confused  impression.     So,   from   a   physiological 


RELATION  TO  HEALTH.  37 

standpoint,  we  see  that  each  minute  point  in  the 
posterior  part  of  the  eye  or  field  of  vision  is  sus- 
ceptible of  taking  a  separate  impression,  and  has 
somewhere  a  distinct  sensory  center  in  the  nerv- 
ous system.  In  looking  directly  in  front  of  me, 
I  see  a  red  light  off  to  the  right,  because  rays 
emanating  from  it  have  fallen  on  that  portion  of 
the  field  of  vision  that  conveys  its  impression  to 
that  particular  center  in  the  brain  that  locates  it, 
and  always  does  locate  any  object  falling  upon  it, 
to  the  right  of  the  optic  axes ;  and  so  it  is  with 
each  minute  and  separate  locality  throughout  the 
entire  field  of  vision.  When  we  contemplate  the 
numerous  objects  that  may  be  distinguished  with- 
out moving  the  eye,  we  may  conceive  how  numer- 
ous must  be  the  sensory  centers  for  the  function 
of  vision.  At  least  one  for  each  angle  of  vision. 
When  the  two  eyes  are  fixed  so  that  rays  of 
light  falling  from  a  given  point  are  reflected  on 
corresponding  localities  in  the  field  of  vision,  a 
single  impression  of  the  object  ensues,  because 
each  of  these  corresponding  points  is  supplied 
with  a  nerve-filament  that  leads  to  a  common  or 
single  sensory  center ;  but  when  rays  coming 
from  the  same  point  fall  on  different  or  non-cor- 
responding localities  in  the  two  eyes,  they  neces- 
sarily meet  with  nerve  filaments  originating  from 
two  different  sensory  centers,  and  each  eye  con- 
veys  an   impression  of  the   same   object  to   dis- 


38  THE  EYE  IN  ITS 

tinctly  separate  centers,  and  two  impressions  of 
the  same  object  are  the  result.  Always,  under 
such  conditions,  there  is  a  strong  effort  of  the 
two  eves  to  fix  their  optic  axes  parallel  so  that 
the  two  apparent  objects  may  be  fused  into  one, 
thus  avoiding  confusion,  and  increasing  the 
sense  of  vision.  In  doing  so,  the  various  mus- 
cles act  as  follows :  Let  two  imaginary  lines 
bisect  each  other  at  right  angles,  one  horizon- 
tallv  and  the  other  vertically,  and  we  shall 
have  a  cross.  Now,  suppose  the  eyes  to  be  out 
of  visual  line  so  that  a  dot  will  appear  to  the 
right  eve  to  be  in  the  lower  right  hand  corner 
of  the  space  occupied  by  the  cross,  and  that  to 
the  left  eve  the  same  object  will  appear  in  the 
left  upper  portion  of  the  cross.  These  impressions 
simultaneously  seen  with  both  eyes  will  appear 
as  two  dots.  To  merge  or  fuse  these  two  im- 
pressions of  the  dot  into  one,  the  external  and 
internal  muscles  move  the  eves  laterally  until 
they  are  in  such  a  position  that  the  two  dots  are 
brought  to  the  imaginarv  vertical  line  of  the 
cross.  One  will  now  be  above  the  other.  This 
we  call  the  tendencv  to  verticalize  exerted  by 
the  internal  and  external  rectus  muscles  ;  while 
at  the  same  time,  the  superior  and  inferior  rectus 
muscles  move  the  eyes  upward  and  downward  to 
such  a  position  that  the  dots  are  brought  to  the 
imaginary  horizontal   line.     This  we  call  the  ten- 


RELATION  TO  HEALTH.  39 

dency  to  horizontalize.  The  vertical  and  lat- 
eral muscles  in  accomplishing  the  above  move- 
ments, receive  some  aid  from  other  muscles. 
This  is  explained  at  length  elsewhere.  These 
tendencies  to  horizontalize  and  verticalize  be- 
ing exerted  simultaneously,  bring  two  impres- 
sions of  a  dot  to  the  center  of  the  cross, 
merging  them  into  one  object.  In  this  posi- 
tion, rays  emanating  from  a  single  point 
fall  on  corresponding  localities  in  each  eye, 
and  are  conveyed  to  a  single  visual  center 
producing  the  impression  of  one.  The  su- 
perior and  inferior  oblique  muscles  also  play 
their  part  in  the  rotations  of  the  eyes,  so  that 
rays  from  a  single  point  may  fall  upon  corre- 
sponding localities.     The  above  process  is  called 

FUSION. 


40  THE  EYE  IN  ITS 


IV. 

WE  give  specific  names  to  disturbances  in 
the  various  parts  or  organs  of  the  body, 
but  still  they  are  nothing  more  than  erratic  func- 
tions, which  may  be  localized  in  the  liver,  kid- 
neys, heart,  digestive  apparatus,  lungs  or  any 
other  part  or  parts  of  the  animal  economy. 

Health  is  that  condition  in  which  all  the  func- 
tions throughout  are  normal  in  their  action. 
Any  departure  of  a  function  or  functions  toward 
an  unnatural  or  abnormal  condition  is  disease. 
Disease  is  the  negative  of  ease  and  means  some- 
thing uncomfortable  or  uneasy ;  but  any  change 
of  function  toward  an  abnormal  condition  should 
be  classified  as  a  disease,  whether  it  manifests 
itself  by  discomfort  or  otherwise. 

Health  is  normal  or  hygienic  physiolog- 
ical   FUNCTION. 

Disease  is  localized  abnormal  innervation 

AND    always     central     IN    THE     NERVOUS     SYSTEM, 
BEING    A    LACK    OR    EXCESS    OF    MOTIVE- FORCE. 

Disease  may  take  its  origin  from  a  suffi- 
cient irritation  of  any  of  the  nerve -centers, 
but  much  oftener  will  disease  find  its  origin 
through  the  most  highly  acute  and  sensitive 
centers. 


RELATION  TO  HEALTH.  41 

What  is  termed  organic  disease  really  consists 
of  some  lesion  of  the  parts  which  is  the  result  of 
continued  imperfect  or  erratic  function,  and  in 
the  true  sense  lesion  is  not  disease  but  the  result 
of  disease. 

The  growth  of  tumors  is  due  to  abnormal  in- 
nervation. In  a  benign  tumor  there  is  an  excess 
of  assimilative  nerve-impulse  which  causes  the 
part  to  gather  unto  itself  more  than  its  propor- 
tionate quantity.  In  a  malignant  tumor  the 
same  condition  exists,  with  the  addition  that  the 
assimilation  consists  of  gathering  to  itself  hete- 
rogeneous elements  forming  a  structure  which  is 
alien  to  the  part. 

In  the  study  of  disease,  we  have  exhausted 
our  fullest  resources  in  searching  for  causes.  We 
find  various  lesions,  such  as  deposit,  disintegra- 
tion, hypertrophy,  atrophy  and  heterogenetic 
conditions,  and  often  have  settled  upon  some  of 
these  lesions  as  being  the  cause  of  other  accom- 
panying pathological  symptoms.  This  is  not 
true,  they  are  nothing  more  than  accompanying 
conditions  or  results  of    disease.      A    lesion    is 

ALWAYS  A  RESULT  AND  NOT  A  CAUSE.   It  may  be 

the  source  of  a  still  further  reflex  disturbance, 
but  back  of  all  of  these  conditions  is  abnormal 
innervation ;  and  from  whatever  source  it  takes 
its  origin,  it  is  the  first  great  disturbing  cause,  in 
all  deranged  functions. 


42  THE  EYE  IN  ITS 

The  electric  current  or  impulse  passes  through 
the  cable,  under  the  ocean,  conveying  intelligence 
from  one  continent  to  another.  It  moves  pon- 
derous machinery  of  various  kinds,  it  traverses 
the  trolley  and  moves  the  heavy  car  loaded  with 
passengers.  Although  unseen,  we  have  learned 
to  look  upon  it  as  a  mighty  force,  as  something 
that  exists,  from  the  fact  of  the  powerful  functions 
that  result  from  its  application.  In  like  manner 
we  must  learn  to  look  upon  motive-force  or 
motive-current  in  the  animal  body  as  the  first  and 
most  important  thing  in  its  very  existence,  for  all 
things  that  are  done  are  accomplished  through  its 
agency  and  nothing  is  accomplished  without  it. 

The  intent  of  this  work  is  to  treat  of  nerve-im- 
pulse, its  equilibrium  or  balance  in  health,  and  its 
lack  of  balance  or  irregularity  in  disease.  In 
speaking  of  eve-strain,  I  always  mean  lack  of  bal- 
ance in  the  nerve-impulses  of  the  eyes,  and  this 
often  exists  to  a  high  degree  when  the  muscle 
balance  is  apparently  perfect. 

The  defects  in  the  eye  muscles  may  be  entirely 
latent  to  diffusion  tests.  I  know  it  is  customary 
when  finding  small  amounts  of  manifest  irregular- 
ities in  some  of  the  eye  muscles  to  suspect  the 
existence  of  a  still  further  defect  in  the  same 
direction,  a  small  portion  of  which  may  slowly 
manifest  itself  during  a  long  course  of  treatment ; 
but  further  than  this  latent  defects  have  not  been 


RELATION  TO  HEALTH.  43 

suspected  or  looked  for.  The  most  obstinate  cases 
of  localized  and  general  nervous  debility  are  more 
frequently  the  result  of  conditions  which  are  abso- 
lutely latent,  with  no  manifest  deviation  to  lead 
us  to  suspect  their  presence.  The  only  thing  that 
leads  us  to  believe  that  latent  eye-strain  exists  is 
the  nervous  derangement  of  the  patient. 

Diseases  of  the  eye,  like  those  of  the  body,  are 
localized  abnormal  innervation.  By  examining  a 
few  individual  cases,  we  can  draw  general  conclu- 
sions which  will  enable  us  to  individualize  any 
disease  of  the  eye  under  the  theory  of  erratic 
function  caused  by  abnormal  innervation.  Abnor- 
mal innervation  of  the  ocular  apparatus  causes 
disturbances  of  the  nerve-centers  and  they  are 
reflexed  to  the  eye,  disturbing  its  nutrition  or  the 
impulses  that  perform  its  various  delicate  func- 
tions. In  cataract,  from  some  disturbing  cause, 
there  is  a  gradual  cessation  of  those  vital  forces 
that  keep  up  the  nutrition,  assimilation  and  life  of 
the  crystalline  lens,  and  it  ultimately  dies, 
becomes  a  foreign,  opaque  body.  In  that  dreaded 
and  generally  incurable  disease  of  the  eye,  glau- 
coma, one  of  the  most  popular  treatments  is 
iridectomy,  also  division  of  the  ciliary  muscle, 
called  cyclotomy.  Occasionally  these  operations 
have  been  known  to  arrest  the  disease,  which,  in 
my  opinion,  they  do  only  when  the  glaucoma  has 
been  dependent  on  latent  hyperopia  or  strain  in 


44  THE  EYE  IX  ITS 

the  ciliary  muscle.  The  iridectomy  as  well  as  the 
division  of  the  ciliary  muscle  would  have  a  ten- 
dency to  suspend  the  tonic  spasm  or  contraction 
of  latent  hyperopia,  and  thus  in  a  measure  restore 
equilibrium  in  the  distribution  of  nerve-force 
to  various  parts  of  the  eye ;  but,  where  these 
operations  fail  to  produce  any  effect  whatever, 
my  opinion  is  that  there  may  be  an  excessive 
strain  in  some  one  of  the  long  muscles  that  is  giv- 
ing rise  to  the  disturbance;  and  if  this  is  carefully 
sought  out  and  operative  measures  resorted  to, 
the  improvement  will  be  as  certain  as  in  those 
cases  that  are  relieved  bv  operations  affecting  the 
ciliary  muscle. 

Various  forms  of  inflammation  of  the  eyes  are 
due  to  disturbances  in  the  nerve-impulses,  and  a 
correction  of  latent  eye-strain,  in  whatever  direc- 
tion it  may  be  found,  often  acts  like  magic  in 
relieving  these  troubles  after  they  have  resisted 
other  treatment.  If  the  examination  is  careful 
and  the  operation  thorough,  rarely  will  the  oculist 
be  disappointed  in  obtaining  good  results.  Any 
disease  of  the  eve,  other  than  zymotic  or  trau- 
matic, and  a  continuance  of  even  these  may  depend 
on  eye-strain. 

The  microbe  theory  as  to  the  origin  of  disease 
is  in  no  way  affected  by  assuming  that  general 
nervous  derangement,  in  some  cases  more  or  less 
localized,  is  the  underlying  or  predisposing  cause 


RELATION  TO  HEALTH.  45 

of  disease  in  general.  If  all  the  organs  and  parts 
of  the  animal  economy  are  receiving  a  generous 
and  adequate  supply  of  motive-force  from  the 
nerve-centers,  the  functions  are  necessarily  per- 
formed with  vigor,  and  the  presence  of  microbes 
of  any  character  does  not  prove  sufficient  to  dis- 
turb these  vigorous  functions.  They  are  continued 
undisturbed  by  the  presence  of  the  microbe, 
apparently  much  the  same  as  an  engine  furnished 
with  a  full  and  vigorous  supply  of  steam  would 
not  be  perceptibly  or  materially  affected  in  its 
movements  though  a  hand  were  to  be  placed  upon 
the  fly  wheel.  It  is  when  the  various  organs  and 
parts  of  the  body  are  furnished  with  a  minimum 
motive-force  from  disturbed  nerve-centers,  just 
barely  enough  force  to  keep  up  the  function,  that 
the  presence  of  the  microbes  is  sufficient  to  inter- 
fere with  the  performance  of  its  work.  In  this 
case  the  microbes  give  rise  to  the  disturbance  of 
certain  functions,  or  to  their  characteristic  disease. 
The  engine  in  this  case  is  supplied  with  so  little 
steam  that  the  placing  of  a  hand  upon  the  fly 
wheel  proves  sufficient  to  disturb  its  normal  action. 
Thus,  in  a  very  plain  and  simple  way,  are  we 
enabled  to  account  for  the  immunity  of  some  per- 
sons from  disease  though  they  have  been  exposed 
to  infection.  Many  theories  have  been  adduced 
to  explain  this,  but  it  is  undoubtedly  correctly 
explained  by  this  theory. 


46  THE  EYE  IN  ITS 

If  twenty  people  were  to  migrate  into  a 
malarious  district,  some  of  them  would  in  time 
succumb  to  the  poisonous  influences  of  the 
malaria,  which  would  induce  fever  and  ague, 
bilious,  dengue,  or  some  other  form  of  fever 
according  to  the  nature  of  the  microbe.  Some 
ten  would  be  constant  victims  of  the  malaria, 
while  ten  of  the  same  company,  who  breathed  the 
same  air  and  drank  the  same  water,  would  enjoy 
perfect  health.  All  take  in  the  poisonous 
influences  in  equal  proportions ;  but  those  of  a 
neurasthenic  predisposition  will  yield  to  the 
baneful  influence,  while  those  whose  functions 
are  perfect  and  vigorous  will  be  able  to  live  for 
years  without  showing  that  they  are  in  any  way 
materially  influenced.  It  is  not,  as  I  have  often 
heard  it  expressed,  that  those  who  do  not  suffer 
throw  off  the  microbe ;  they  take  it  into  their 
systems  in  the  same  proportions  as  those  who 
yield  to  disease,  but  their  functions  are  so  per- 
fectly and  strongly  performed,  that  the  presence 
of  the  microbe  fails  to  disturb  their  action. 

Viewing  all  disease  as  localized  nervous 
derangement,  it  will  not  be  necessary  to  enumer- 
ate the  whole  category  of  ills,  but  a  few  promi- 
nent ones  will  suffice,  and  the  same  general 
reasoning  can  then  be  applied  to  all  the  rest,  for 
disease  is  not  a  thing,  an  entity.  We  have 
various  erratic,  abnormal  actions  in  certain  func- 


RELATION  TO  HEALTH.  47 

tions  of  the  body,  and  we  give  them  names.  For 
instance;  if  a  patient  has  excessive  thirst,  and  the 
kidneys  are  secreting  a  great  amount  of  water, 
the  liver  has  taken  upon  itself  through  erratic 
action  to  manufacture  larger  amounts  of  sugar 
than  are  to  be  met  with  in  a  state  of  health  ;  we 
name  these  functional  derangements  diabetes 
mellitus.  A  large  train  of  other  symptoms  which 
vary  greatly  in  different  cases  will  be  noted  in 
various  forms  of  this  disease,  from  the  fact  that 
the  irritation  in  the  central  nervous  system  is  so 
varied  in  its  character  that  it  sends  out  corre- 
sponding impulses  which  perform  erratic  work  in 
various  parts  of  the  body.  Whatever  the  nature 
of  the  erratic  function  that  falls  to  the  liver, 
spleen,  or  kidneys,  it  is  entirely  due  to  the 
character  of  its  nerve-impulses.  In  diabetes, 
it  is  safe  to  say  there  is  not  a  function  in 
the  whole  animal  economy  that  may  not 
be  coincidently  more  or  less  deranged  or  erratic; 
but  whatever  the  nature  and  train  of  symp- 
toms, the  name  of  diabetes  mellitus  will 
prevail,  provided  an  excessive  quantity  of  urine 
containing  sugar  is  secreted,  accompanied  with 
the  usual  diabetic  thirst.  To  enumerate  and  par- 
ticularize, in  all  the  cases  of  functional  disturbances 
that  might  present  themselves,  would  require  the 
space  of  volumes.  The  names  of  diseases  are 
useful,   inasmuch    as    they  suggest  to  the    prac- 


48  THE  EYE  IN  ITS 

titioner  of  medicine,  a  certain  combination  of 
disturbed  functions.  When  an  irritation  in  the 
nerve-centers  arises  from  injury,  it  is  called  trau- 
matic. When  it  arises  from  other  causes  than 
injury,  it  is  called  idiopathic.  It  makes  no  dif- 
ference whether  the  nerve-centers  receive  their 
disturbing  cause  through  the  one  source  or  the 
other,  they  are  still  irritated  or  disturbed  nerve- 
centers  ;  and  in  either  event  the  position  we  have 
taken  is  in  no  way  altered,  that  disease  is  always 
localized  abnormal  innervation. 

Various  forms  of  catarrh  are  localized  nervous 
derangements.  The  inflammation  of  the  mucous 
membrane  of  the  nose,  ear,  throat  or  other  parts  that 
are  affected,  is  a  result  of  a  pre-existing  condition, 
namely  an  unnatural  or  excessive  sensibility  of 
this  membrane ;  which  simply  means  that  the 
nerve-centers  are  supplying  this  membrane  with 
nerve  or  motive-force  of  such  a  character  that  it 
takes  offense  at  very  slight  changes  in  the  tem- 
perature of  the  atmosphere.  Again,  the  pollen 
and  perfume  of  flowers  sometimes  give  rise  to  hay 
fever,  asthma  and  various  forms  of  catarrh.  All 
this  is  because  the  nerve-impulse  that  is  supplying 
the  part  is  so  excessively  abnormal  in  the  way  of 
sensibility,  that  things  otherwise  inoffensive  pro- 
duce serious  results.  It  is  not  the  nerves  that  are 
affected ;  they  are  simply  conveyors  of  sensitive 
nerve-force.     They   themselves   are   passive   and 


RELATION  TO  HEALTH.  49 

without  feeling.  It  is  the  impulse  that  passes 
through  the  nerves  that  characterizes  the  peculiar 
irritability  or  hypersensitiveness  of  the  membrane, 
and  this  gives  rise  to  the  inflammatory  action  that 
follows. 

Alcoholism  is  a  form  of  abnormal  innervation 
which  manifests  itself  in  an  irritable  craving  for 
alcoholic  stimulus.  It  is  not  necessary  to  dilate 
on  the  different  forms  of  drunkenness  further  than 
to  mention  the  habitual  and  the  periodic  drinker. 
The  habitual  drinker  has  a  steady  or  fixed  irrita- 
bility in  the  nerve-centers  that  gives  rise  to  a 
constant  desire  for  stimulus.  A  periodic  drinker 
is  one  in  whom  there  is  a  gradual  and  steady  in- 
crease of  irritability  in  the  nerve-centers  until  a 
climax  is  reached.  When  this  period  arrives  all 
judgment  is  set  aside;  and  with  the  knowledge  of 
previous  errors  staring  him  full  in  the  face,  even 
the  death  of  a  parent,  wife  or  child,  he  insanely 
drains  the  cup  to  the  bitter  dregs  again  and  again. 
The  dipsomaniac  is  certainly  insane.  I  have  seen 
him  kneel  in  prayer  and  beg  for  help  against  his 
infirmities,  and  truly  his  prayer  was  earnest  and 
his  heart  sincere ;  yet  ere  he  arose  from  his  knees, 
he  drew  from  his  pocket  a  flask  of  whiskey  and 
drank  deeply  of  it.  If  there  are  superlative  de- 
grees of  heartache  and  yearning,  they  are  in  the 
breasts  of  drinking  men,  in  their  burning  desire 
to  be  free  from  the  thraldom  of  drink. 
4 


50  THE  EYE  IN  ITS 

As  to  this  form  of  derangement  finding  its 
origin  through  the  visual  centers,  I  desire  to  call 
attention  to  one  prominent  fact.  Among  various 
treatments  for  dipsomania  or  drunkenness,  are 
those  that  involve  the  use  of  remedies  usually 
applied  by  hypodermic  injection  which  causes  a 
dilation  of  the  pupils  of  the  eyes.  This  dilated 
condition  is  usually  continued  for  about  the 
space  of  one  month.  Whatever  the  remedy  is,  it 
acts  as  a  mvdriatic.  It  acts  by  relaxing  spasm 
in  the  ciliary  muscle.  It  also  dims  the  vision 
more  or  less,  so  that  the  stimulus  to  fix  both  eyes 
in  a  parallel  plane  with  each  other  is  lessened; 
and  if  there  be  a  short  upper,  under,  inner,  or 
outer  muscle,  there  is  but  little  stimulus  to  exert 
its  strain ;  also  the  vision  is  fogged,  and  all  this 
relaxation  lessens  the  labor  of  the  visual  centers. 
My  opinion  is  that  so-called  cures  for  dipsomania 
perform  whatever  good  they  effect  by  temporarily 
relieving  eye-strain.  This  is  also  verified  by  the 
fact  that  the  same  nervous  conditions  are  equally 
benefited  by  dropping  a  mvdriatic  such  as  hyoscy- 
amine,  hyoscine  or  atropine  into  the  eye,  thus 
dilating  the  pupil  and  relaxing  ciliary  strain,  and 
at  the  same  time  lessening  the  acuity  of  vision,  so 
that  the  stimulus  for  parallelism  is  also  lessened. 
During  the  time  the  eyes  are  kept  in  this  dim, 
relaxed  condition,  there  is  a  cessation  from  eye- 


RELATION  TO  HEALTH.  51 

strain  and  the  brain  irritation  dependent  on  it, 
and  the  craving  for  drink  ceases  ;  but  after  the 
remedy  has  ceased  to  be  administered,  and  the 
effect  has  passed  from  the  system,  there  will 
usually  be  a  return  of  the  same  old  strains,  induc- 
ing a  return  of  the  irritation  of  the  nerve-centers, 
bringing  back  the  old  appetite,  or  at  least  a  condi- 
tion in  which  the  appetite  is  readily  awakened  by 
sight,  taste  or  smell.  There  are  natures  of  suffi- 
cient strength  to  continue  an  abstemious  life  after 
the  aid  of  treatment  has  once  been  given  them ; 
but  again  there  are  men  who,  when  the  irritation 
returns,  are  helpless ;  their  passionate  impulses 
are  uncontrollable.  Those  who  are  able  to  resist 
drink  after  the  brain  irritation  returns,  are  often 
visited  by  some  other  form  of  affliction  in  its 
stead,  such  as  disease  of  the  heart,  liver,  kidneys, 
sexual  organs  or  lungs.  Conversely,  we  are  often 
able  to  arrest  and  delay  the  progress  of  consump- 
tion by  the  use  of  liquor,  establishing  a  form  of 
alcoholism  that  utilizes  those  abnormal  impulses 
which  were  performing  the  function  of  building  up 
tubercular  tissue ;  their  office  is  really  perverted 
and  the  disease  thus  arrested. 

A  man  may  love  the  taste  or  the  smell  of 
liquor,  but  without  any  effort  on  his  part,  can  use 
it  sparingly.  He  has  really  no  appetite  for  it, 
although  the  taste  and  smell  are  pleasant  to  him. 


52  THE  EYE  IN  ITS 

Again,  a  victim  who  has  a  vicious  appetite  may 
hate  the  taste,  smell  and  sight,  yet  for  his  life,  he 
cannot  be  prevented  from  drinking  it. 

The  supposition  of  the  masses  in  their  obser- 
vation of  drinking  men,  is  that  such  unfortunates 
resort  to  the  use  of  alcoholic  stimulus  for  the 
dissipation,  for  the  pleasure  they  find  in  it  ;  but 
this  view  is  absolutely  incorrect.  These  men 
drink  for  the  purpose  of  diverting  the  horrors 
of  constantly  increasing  nervous  irritability, 
which  ultimately  becomes  absolutely  unbearable 
and  incompatible  with  sanity. 

Alcohol  acts  on  the  nerve-centers  by  first 
exalting  their  action,  and  then  for  a  time  sustain- 
ing such  an  extravagant  call  upon  them  that, 
sooner  or  later,  they  become  absolutely  ex- 
hausted and  are  unable  to  furnish  any  more  vital 
force  than  is  just  necessary  to  carry  on  the  un- 
conscious functions  of  life.  Physical  strength 
passes  away,  the  reasoning  powers  take  flight, 
and  unconsciousness  ensues,  for  lack  of  vital 
force  to  carry  on  these  functions.  During  this 
period  of  prostration,  all  abnormal  innervations 
that  were  a  source  of  irritation  to  the  brain  are 
suspended.  When  the  nerve-centers  begin  to 
recuperate  and  build  up,  there  is  a  gradual  re- 
establishment  of  those  abnormal  innervations  or 
strains,  until  they  are  again  so  excessive  as  to  be 
unbearable    and   a  debauch    is  resorted    to  once 


RELATION  TO  HEALTH.  53 

more  as  a  relief.  Now  by  determining  just 
where  these  abnormal  innervations  are,  and  just 
what  is  the  cause  of  them,  we  may  correct  these 
strains  and  abnormal  innervations,  and  thus 
relieve  the  patient  without  any  risk  of  a  return  of 
the  uncontrollable  appetite  and  without  the  risk 
of  some  other  disease  in  its  stead. 

An  inflammation  in  any  part  of  the  body  is 
the  result  of  an  irritant  nerve-supply  to  the 
affected  part,  whereby  the  sensibility  of  the  part 
is  emphasized  to  a  higher  or  abnormal  degree. 
The  nerves  of  the  smaller  blood  vessels  (vaso- 
motor-nerves)  carry  the  impulses  that  cause  the 
derangement ;  congestion  follows  and  inflamma- 
tion ensues. 

Frequently  one  inflammation  is  relieved  by 
producing  another,  a  method  that  we  call  coun- 
ter-irritation ;  e.g.,  by  a  mustard  plaster  or  a  vesi- 
cant. This  establishes  its  inflammatory  or  irri- 
tant action  by  sending  to  the  nerve-centers 
impulses  that  stimulate  them  to  return  that 
impulse  that  gives  rise  to  the  inflammation  that 
we  wish  to  establish.  Although  the  result  is 
local,  the  action  of  the  irritant  is  not.  Often 
has  the  practitioner  applied  a  counter-irritant 
when  it  failed  to  produce  the  desired  irritation, 
from  the  fact  that  the  nerve-centers  were  in  such 
a  low  and  enfeebled  state  that  they  were  unable 
to  respond.     In  mumps,  there  is  an  inflammation 


54  THE  EYE  IN  ITS 

of  the  parotid  gland  and  sometimes  a  curious 
thing  occurs ;  the  inflammation  in  the  parotid 
suddenly  ceases  and  at  once  makes  its  appear- 
ance in  the  testicle  or  ovary.  This  sudden 
change  of  the  seat  of  inflammation  from  one 
part  of  the  body  to  the  other,  not  affecting  any 
of  the  intervening  spaces,  has  been  called  metas- 
tasis, and  at  first  may  look  like  a  strange  and 
unaccountable  phenomenon ;  but  it  is  not  diffi- 
cult to  understand  when  we  consider  that  it  is 
that  portion  of  the  nerve-centers  that  presides 
over  the  parotid  that  is  disturbed  and  sending 
irritant  nerve-force  to  the  gland,  causing  the  in- 
flammation, and  that  there  occurs  a  switching  or 
change  of  this  irritation  from  this  nerve-center  to 
the  one  supplying  the  testicle  or  ovary  which  is 
probably  conveniently  located  for  the  purpose  of 
change.  The  instant  the  irritation  changes  from 
one  nerve-center  to  the  other,  the  inflammatory 
action  changes  its  location. 

Ovaritis,  or  inflammation  of  the  ovaries,  from 
whatever  source  it  may  have  taken  its  origin,  is 
always  due  to  a  disturbance  of  the  nerve-centers 
that  preside  over  the  ovarian  functions. 

Parturition  or  child-birth  as  well  as  the 
monthly  organic  functions  of  the  ovaries,  can 
only  be  exciting  and  not  primary  causes  of  ova- 
ritis; for  if  their  presiding  nerve-centers  are  vig- 
orous   and    generous    in    their    supply  of   nerve- 


RELATION  TO  HEALTH.  55 

impulse,  these  organs  always  recover  from  dis- 
turbances excited  by  the  above  causes.  But 
when  they  do  not  recover  their  normal  condi- 
tions, the  failure  results  from  a  lack  of  equilibri- 
um in  the  nerve-impulses,  and  ovaritis  is  the 
result.  A  long  continuance  of  the  disturbed 
conditions  that  interfere  with  the  organic  and 
assimilative  functions  of  these  parts,  may  ulti- 
mately give  rise  to  lesions,  the  growth  of  cysts 
and  tumors  of  various  characters,  also  displace- 
ments due  to  a  weakened  condition  of  support- 
ing appendages.  The  pain  and  suffering  in  these 
parts  is  central;  all  feeling  is  in  the  nerve-centers, 
and  only  apparently  located  in  the  parts  of  the 
body  where  we  seem  to  note  it.  Oftentimes 
feeling  continues  to  exist  apparently  in  an  absent 
part  which  has  been  removed  even  for  many 
years ;  for  instance  a  leg.  But  recently  I  asked  a 
patient  whose  leg  I  amputated  twenty-five  years 
ago  if  his  old  gout  ever  troubled  him  in  that  part 
now.  His  answer  was,  "Yes,  very  badly;  but  I 
cannot  get  my  foot  in  hot  water  as  I  used  to, 
consequently  I  have  to  suffer  the  pain.  Some- 
times my  toes  get  crossed,  and,  not  being  able  to 
touch  them,  I  am  unable  to  relieve  the  disagreea- 
ble feeling."  The  nerve-centers  that  once  pre- 
sided over  the  foot  were  in  a  disturbed  condition 
and  caused  the  unpleasant  feelings  complained 
of.      Every   surgeon   is   familiar   with   such   com- 


5^  THE  EYE  IN  ITS 

plaints,  and  they  teach  us  conclusively  that  the 
feeling  of  all  parts  is  in  the  central  nervous 
system. 

All  medicines  or  remedies  are  administered 
with  the  expectation  or  hope  that  they  will  cor- 
rect whatever  disturbed  functions  the  disease  may 
consist  of.  The  end  sought  is  to  reestablish  nor- 
mal action  in  the  nerve-centers  and  thus  restore 
perfect  function.  Whether  the  nerve-center  is 
influenced  by  impulse  from  without,  or  by  remedy 
taken  into  the  circulation  and  carried  directly  to 
the  part,  the  action  is  the  same.  Just  what 
change  takes  place  in  the  nerve-centers  is  some- 
what a  matter  of  speculation.  We  think  we  have 
strong  reasons  for  believing  it  to  consist  of 
changes  in  polarity. 

The  Homeopathic  principle  of  administering 
remedies  for  disease  is  similia  similibus  curan- 
TUR,  (or  like  cures  like)  and  is  based  on  the  fact 
that  a  certain  remedy  administered  in  health 
causes  changes  in  the  function  of  some  particular 
organ  or  part.  Now,  when  this  part  becomes 
diseased,  the  conclusion  is  that  the  remedy  hav- 
ing a  predilection  to  act  on  these  parts  will  tend 
to  restore  them  to  normal  action.  Whatever 
changes  are  wrought  originate  in  the  nerve- 
centers.  How  can  it  be  possible  to  disturb  a 
healthy  function  without  first  disturbing  the  pre- 
siding center?     Even  in  the  case  of  injurv  to  a 


RELATION  TO  HEALTH.  57 

part,  inflammatory  action  does  not  ensue  until 
the  nerve-centers  have  received  the  irritant  impulse 
from  the  shock  or  injury;  and  then  they  return  their 
characteristic  impulses  to  the  injured  part,  estab- 
lishing the  inflammatory  action  which,  under 
favorable  circumstances,  tends  to  repair  the 
injury. 


58  THE  EYE  IN  ITS 


V. 


WE  step  upon  a  rough  pebble.  It  hurts. 
The  fact  is,  that  when  the  nerves  of  any 
part  of  the  body  come  in  contact  with  any  sub- 
stance with  sufficient  force,  that  contact  produces 
an  impulse  or  current  which  traverses  the  nerves 
to  the  brain  or  central  nervous  system.  This  cur- 
rent sent  from  the  outside  or  periphery  to  the 
central  nervous  system,  is  called  an  afferent  cur- 
rent. The  nerve-center  receives  this  afferent 
impulse,  and  responds  by  generating  and  sending 
back  to  the  parts  and  their  surroundings  that 
were  originally  interfered  with,  a  current  or 
impulse  which  is  called  an  efferent  current;  it  is 
also  called  reflex,  being  sent  back  as  an  image  of 
an  object  is  sent  back  from  a  mirror.  In  medical 
practice  we  meet  with  many  serious  disturbances 
arising  from  what  we  call  reflex  causes. 

Frequently  has  it  occurred  in  the  experience  of 
the  dentist,  that  in  removing  a  diseased  tooth,  he 
has  also  removed  the  immediate  cause  of  a 
serious  neuralgia,  some  form  of  headache  or  other 
nervous  disorder;  the  gynaecologist  records  many 
instances  where  displaced  organs  have  been  the 
cause  of  reflex  diseases  in  other  parts  of  the  body; 


RELATION  TO  HEALTH.  59 

the  catarrh  specialist  has  found  enlarged  or 
hypertrophied  turbinated  bones  to  have  been  the 
cause  of  serious  reflex  diseases;  the  rectal 
specialist  has  recorded  many  important  cures  of 
various  diseases  in  other  parts  by  the  relief  of 
some  local  disease.  Pathology  records  similar 
reflex  diseases  to  an  extensive  degree  and  also 
relief  by  a  correction  of  the  local  disturbance ; 
and  the  latter  has  sometimes  been  regarded  as 
the  primary  cause  of  the  reflex  disease,  but  this 
conclusion  is  in  all  cases  erroneous.  For 
example,  let  us  suppose  that  ovaritis  gives  rise  to 
some  reflex  disease;  the  fact  that  the  ovaritis  is 
itself  the  result  of  some  prior  cause  shows  that, 
as  a  causative  agent,  it  cannot  be  primary.  So 
numerous  have  been  such  cases  and  their  relief 
through  each  separate  branch  of  orificial  surgery, 
that  some  in  each  department  have  become  so 
enthusiastic  as  to  believe  that  nearly  all  diseases 
find  their  origin  through  the  disturbances  found 
in  their  particular  line  of  work.  Any  and  all  of 
these  views,  taken  at  first  sight  and  considered 
separately,  have  apparently  much  evidence  in 
their  favor;  but  that  they  are  all  erroneous  is 
evident  from  the  fact  that  while  these  reflex 
troubles  had  resulted  from  the  special  diseases 
which  were  treated,  these  special  diseases  them- 
selves must  each  have  had  a  cause  which  must 
still  be  accounted  for.     Consequently,  any  theory 


6o  THE  EYE  IN  ITS 

which  relies  on  some  diseased  condition  as  the 
fundamental  factor  in  the  origin  of  disease,  must 
necessarily  be  wrong,  from  the  fact  that  the  pri- 
mary disease  is  itself  still  unaccounted  for. 

I  wish  to  be  distinctly  understood  as  advo- 
cating the  importance  of  correcting  all  such 
disturbances  locally,  as  well  as  removing  the 
cause  of  their  origin.  The  relief  that  is  af- 
forded by  giving  them  attention,  is  in  many  cases 
truly  wonderful.  What  I  wish  to  point  out  par- 
ticularly is  the  origin  of  the  local  disturbance, 
for  it  may  be  a  secondary  or  tertiary  cause  of 
reflex ;  and  if  we  do  not  dip  still  further  into  the 
mystery  of  our  trouble,  that  which  was  the  pro- 
moter of  the  primary  local  disturbance  will  turn 
in  some  other  direction  and  continue  its  devasta- 
tion of  the  nerve-centers,  and  the  patient,  although 
from  time  to  time  relieved  of  various  local  diffi- 
culties, will  be  forever  a  sufferer.  This  is  fairly 
substantiated  bv  the  cases  of  a  laro^e  number  of 
nervous  women  who  have  submitted  to  a  removal 
of  the  ovaries  for  the  relief  of  nothing  more  than 
chronic  ovaritis.  If  the  patient  recovers  from 
the  operation,  it  is  usually  recorded  as  a  success- 
ful one.  True,  the  local  disturbances  have  been 
relieved,  as  rheumatism  in  the  leg  would  be  by 
amputating  the  limb  ;  but  the  central  irritation 
that  gave  rise  to  it  generallv  continues  and 
expends    its    fury   in    some   other   direction.     At 


RELATION  TO  HEALTH.  6l 

least,  this  has  been  my  observation  in  no  less 
than  eighty-four  cases.  This  unsexing  of  women 
because  of  no  other  disorder  than  chronic 
ovaritis,  will  in  a  great  majority  of  cases  be 
abandoned ;  for  a  more  perfect  general  relief  from 
these  troubles  will  be  found  in  less  stringent 
measures.  Clinical  experience  has  repeatedly 
demonstrated  the  truth  of  this  statement. 

Every  local  disturbance,  to  whatever  specialty 
it  belongs,  has  some  cause  back  of  it,  some  ab- 
normal nerve-impulse  that  gives  birth  to  the 
unnatural  conditions.  In  rectal  disease  a  consti- 
pated habit  exists  which  in  itself  is  simply  a 
lack  of  impulse  to  perform  the  functions  of  the 
bowels. 

Habitual  constipation  is  always  an  evidence  of 
nerve-center  derangement,  a  condition  in  which 
there  is  a  failure  of  the  dynamic-center  to  send  to 
the  bowels  a  sufficient  amount  of  motive-force  to 
perform  the  function  of  absorption,  secretion  and 
muscular  action,  necessary  to  carry  on  the  daily 
offices  of  health  in  these  parts.  The  derangement 
is  in  the  nerve-centers,  and  any  relief  that  is 
obtained  from  this  condition  must  always  be 
obtained  by  regulating  the  action  of  the  nerve- 
centers  that  govern  the  bowels. >  A  pill  or  any 
cathartic  is  taken  into  the  mouth,  and  passes  on 
through  the  stomach  into  the  intestines.  Its 
presence  there  acts  as  an  irritant  which  sends  an 


62  THE  EYE  IN  ITS 

afferent  impulse  to  the  nerve-centers ;  from 
thence  is  reflected  an  efferent  impulse  that  car- 
ries to  the  bowels  a  working  motive-force  that 
sets  their  various  functions  in  motion  and  an 
action  ensues.  Often  has  the  medical  practitioner 
met  with  a  case  of  constipation  existing  in  con- 
nection with  some  serious  disease  that  has 
resisted  the  action  of  the  strongest  purgatives  ; 
locally,  these  remedies  have  reached  the  bowels ; 
but  the  low,  disturbed  state  of  the  nerve-centers 
has  been  such  that  they  have  not  been  awakened 
to  respond  to  the  irritant  impulse,  which  was  sent. 
Sometimes  constipation  will  be  the  only  promi- 
nent local  defect  in  general  nervous  derangement. 
In  many  cases,  we  find  constipation  coexistent 
with  general  nervous  debility  and  various  forms 
of  local  derangement ;  but  it  may  always  be  con- 
sidered a  nerve-center  derangement  and  the 
opposite  of  chronic  diarrhoea,  which  is  due  to  an 
excess  of  motive-force  to  the  bowels  from  irritant 
causes.  When  the  motive-forces  or  impulses 
proceed  from  healthy  nerve-centers  and  pass 
along  the  nerves  that  carry  them  to  the  entire 
digestive  apparatus,  there  is  perfect  secretion, 
perfect  digestion,  perfect  absorption  and  perfect 
daily  movement  constituting  health  in  these  parts. 
It  is  the  lack  of  such  innervation  in  some  part  or 
parts  which  gives  rise  to  the  various  distur- 
bances. 


RELATION  TO  HEALTH.  63 

The  secretion  or  manufacture  of  the  various 
constituent  parts  of  the  digestive  fluids,  such  as 
pepsin,  diastase,  lactic  acid,  hydrochloric  acid, 
bile,  in  short  all  organic  products,  is  the  direct 
outcome  of  the  peculiar  nature  of  the  nerve-im- 
pulses to  the  various  organs,  and  is  largely  char- 
acterized by  the  peculiar  form  and  structure  of 
the  parts  that  do  the  work.  These  are  the  little 
engines,  and  any  alteration  in  their  nerve-impulses 
causes  a  derangement  in  the  products  of  their 
work.  It  is  easy  to  conceive  of  such  an  abnormal 
alteration  in  the  motive-impulses  as  to  produce 
uric  acid  and  other  abnormal  products  which  are 
found  in  various  diseases.  The  presence  of  uric 
acid  is  said  to  be  the  cause  of  certain  diseases, 
whereas  the  truth  is,  that  which  is  the  cause  of 
the  uric  acid  is  the  primary  case  of  these  diseases; 

AN  ABNORMAL  IMPULSE  BRINGS  FORTH  AN  ABNORMAL 
PRODUCT. 

The  results  of  nerve  transplantation  are  posi- 
tive evidence  that  the  function  is  not  characterized 
by  the  peculiarity  of  the  nerve,  for  we  can  trans- 
plant efferent  nerve  fibre  to  the  place  where 
afferent  has  been  without  altering  the  character 
or  nature  of  the  function. 

But,  is  there  really  more  than  one  kind  of 
nerve-force  ?  Although  we  speak  of  impulses  as 
motive  and  sensory,  or  those  that  perform  functions 
of  motion  and  feeling,  besides  these  we  also  have 


64  THE  EYE  IX  ITS 

nerve-impulses  that  are  performing  the  functions 
of  assimilation,  and  again  those  that  are  perform- 
ing more  complex  organic  functions.  Instead  of 
these  varied  functions  being  due  to  different  kinds 
of  nerve-force,  is  it  not  possible  that  the  anatomi- 
cal or  histological  structure  of  the  various  parts 
in  connection  with  an  adequate  supply  of  nerve- 
force,  is  that  which  dominates  the  nature  of  the 
function  ?  If  so,  only  quantity  need  be  consid- 
ered in  all  changes. 

We  do  not  inherit  disease,  but  we  inherit  those 
conditions  which  give  rise  to  disease,  such  as 
imperfect  anatomical  structure  of  parts  which, 
for  the  performance  of  their  functions,  require 
excessive  nerve- force;  also  imperfectly  developed 
nerve-centers,  which  are  predisposed  to  localized 
irritation.  Thus  by  heredity  we  may  be  liable  to 
a  particular  train  of  diseases,  such  as  consump- 
tion, alcoholism,  diabetes,  Bright's  disease,  vari- 
ous forms  of  catarrh,  with  a  tendency  to  that 
weak  condition  which  especially  renders  one  a 
victim  to  malarious  and  contagious  diseases. 

"Tubercular  consumption  is  not  a  local  but  a 
constitutional  disease,  and  calls  for  general  treat- 
ment. Tubercle  bacilli  do  not  and  cannot  cause 
consumption  in  a  perfectly  healthy  individual. 
They  induce  disease  only  in  persons  with  lowered 
vitality,  who  thus  become  susceptible  to  their 
influence." 


RELATION  TO  HEALTH.  65 

The  most  prominent  pathological  change  in 
motor-ataxy  or  tabes  dorsalis  is  located  in  the 
spinal  cord.  Tabes  dorsalis  is  not,  as  has  been 
carelessly  affirmed,  the  cause,  but  it  is  one  of  the 
results  of  disease ;  and  the  changes  in  the  spinal 
column  are  due  to  causes  anterior  to  them,  affect- 
ing the  nutrition  of  these  parts,  and  the  sclerosis 
follows.  I  speak  particularly  of  this,  because  we 
are  frequently  prone  to  select  some  predominant 
pathological  condition  of  a  disease  and  attribute 
the  disease  to  that  as  its  cause,  whereas  it  is  only 
one  of  its  results,  concomitant  conditions,  or  prom- 
inent lesions.  But  these  pathological  conditions 
may  act  as  causes  for  the  establishment  of  still  fur- 
ther reflex  diseases,  producing  localized  disturb- 
ances that  act  as  secondary  reflexes,  the  influence 
going  further  and  further  until  we  have  reflex 
causes  quite  a  number  of  removes  from  the  pri- 
mary. 

The  fact  that  great  relief  has  followed  the  cor- 
rection of  local  disturbances  of  the  rectum,  female 
organs,  nasal  passages  and  local  irritation  of  other 
parts  of  the  body,  all  of  which  are  abnormal 
innervations,  ought  to  lead  us  to  expect  even 
greater  relief  from  the  correction  of  an  abnor- 
mal innervation  through  the  visual  centers,  for 
they  are  much  more  acute  than  any  of  those 
nerve-centers  that  preside  over  and  govern  the 
action  of  other  parts  of  the  body. 
5 


66  THE  EYE  IN  ITS 

In  determining  the  cause  of  a  disease,  it  is 
very  important  to  discriminate  between  exciting 
and  predisposing  causes,  for  we  commit  an  error 
in  resting  our  judgment  on  some  exciting  cause 
as  being  the  sole  element  of  the  disturbance. 
This  can  always  be  laid  down  as  a  wrong  conclu- 
sion where  the  same  or  a  similar  exciting  cause 
fails  to  bring  about  universally  similar  results. 
If  the  same  exciting  causes  are  brought  to  bear 
on  two  persons  and  one  is  affected  by  them  and 
the  other  not,  there  is  somewhere  a  difference  in 
the  two  individuals.  There  is  a  predisposition  in 
one  which  causes  him  to  yield  to  the  exciting 
causes.  In  the  other  the  predisposition  does  not 
exist.  Whatever  may  be  the  disease  arising  from 
an  exciting  cause,  this  reasoning  will  hold  good. 

Exciting  causes  may  be  a  draught  of  air,  wet 
feet,  exposure  to  cold,  the  monthly  physiological 
processes  in  women,  pregnancy,  over-exhaustion, 
poisonous  gases,  malarial  and  infectious  germs, 
injuries,  excitement,  grief,  poisonous  drugs  of 
various  kinds,  opium,  cocaine,  bromides,  mercury, 
lead,  alcohol,  tobacco,  and  quite  an  extended  list 
might  be  made.  The  action  of  any  of  these 
is  emphasized  by  predisposing  causes ;  for  a  large 
class  of  individuals  in  a  general  sense  have 
immunity  from  the  effect  of  some  of  the  above 
causes  especially  the  after  effects  of  narcotics  and 
poisons.    Any  investigation  of  a  disease  is  remiss  if 


RELATION  TO  HEALTH.  67 

it  stops  at  exciting  causes.  Acting  in  conjunction 
with  predisposing  causes  there  may  be  several 
exciting  causes  that  give  rise  to  a  disease  and  its 
continuance.  A  general  neurasthenic  condition 
will  be  a  predisposing  cause;  and  tobacco,  alcohol, 
malaria,  over-work,  change  of  life  and  exposure 
to  cold  may  all  be  exciting  causes  in  bringing  on 
a  disease.  Because  we  have  found  one  prominent 
cause  for  a  disease,  we  should  not  relax  our  search 
for  others. 


68 


THE  EYE  IN  ITS 


VI. 


EACH  eye  has  seven  muscles  which  perform  all 
the  movements  necessary  in  the  functions  of 
vision.  Four  of  them  are  called  recti  or  straight 
muscles,  as  follows :  the  superior  rectus   muscle 


EYE   MUSCLES. 

Ciliary  muscle  (within  the  ball).  4.  Superior  rectus. 


2.  Internal  rectus. 

3.  External  rectus. 


upe 

5.  Inferior  rectus. 

6.  Superior  oblique. 
7.  Inferior  oblique. 


turns  the  eye  upward,  the  inferior  downward,  the 
external  outward,  the  internal  inward  or  toward 
the  nose ;  two  are  called  the  superior  oblique  and 
the  inferior  oblique,  the  offices  of  which  are  to 
rotate  the  eye  on  its  antero-posterior  axis.  The 
seventh  is  the  ciliary  muscle  which  is  within  the 
eye-ball  and  surrounds  the  crystalline  lens.  Some 
of  the  above  mentioned  muscles  are  assisted  in 
the  performance  of  their  functions  by  other  mus- 
cles.    This  is  explained  at  length  farther  on. 


RELATION  TO  HEALTH.  69 

When  we  think  of  the  complex  arrangement 
of  these  muscles  in  the  two  eyes,  we  must  know 
that  for  the  easiest  possible  vision,  it  is  necessary 
that  they  should  be  absolutely  perfect  as  to  length 
and  their  attachments ;  also  that  the  crystalline 
lens  should  be  anatomically  correct.  Here  we 
have  in  the  two  eyes,  sixteen  anatomical  parts 
that  must  be  without  fault.  This  naturally  leads  us 
to  infer  that  the  perfect  eye  is  an  exception,  and  a 
wide  experience  has  taught  us  that  irregularities  in 
in  some  of  these  parts  are  very  common.  It  would 
be  marvelous  if  one  pair  of  eyes  in  a  hundred  were 
absolutely  balanced  without  the  intervention  of 
nerve-impulse  to  overcome  some  slight  defect. 
These  muscles  are  often  so  imperfect  in  length  and 
irregular  in  their  attachments,  as  to  cause  the  eyes 
to  deviate  many  degrees  from  the  normal  position. 
When  the  axes  of  vision  deviate  so  far  that  it  is 
impossible  for  the  nerve-impulses  to  pull  them 
back  into  line,  we  have  a  condition  commonly 
known  as  strabismus  or  squint.  The  deviation 
may  be  outward,  inward,  upward,  downward,  or  a 
combination  of  two  of  these  directions.  When 
the  angle  of  deviation  is  so  great  that  it  cannot 
be  corrected  by  the  nerve-impulses  that  operate 
these  muscles,  the  effort  to  produce  single  vision 
becomes  more  or  less  suspended  and  the  laborious 
work  of  the  nerve-centers  is  abandoned.  Usually 
one  of  the  eyes  suppresses  its  vision;  for,  as  long 


70  THE  EYE  IN  ITS 

as  double  vision  of  the  same  object  exists,  there 
will  always  be  an  effort  to  fuse  the  two  images 
into  one  for  the  sake  of  avoiding  confusion  and 
increasing  the  sense  of  sight. 

Defects  in  various  parts  of  the  eye,  including 
the  muscles  as  to  their  length,  may  exist  to  a 
very  considerable  extent  and  yet  the  function  of 
vision  be  perfectly  performed.  Some  of  the  mus- 
cles may  be  so  short  that  they  would  cause  the 
optic  axes  of  the  two  eyes  to  deviate  many 
degrees  if  it  were  not  that  the  opposite  muscles 
pull  them  into  a  normal  position,  through  the 
intervention  of  nerve-impulse.  Nerve-impulse  is 
also  the  primary  factor  in  causing  the  ciliary  mus- 
cle to  contract  around  the  crystalline  lens,  increas- 
ing its  refractive  power  when  it  is  deficient.  Just 
how  fixed  and  permanent,  through  a  long  lapse  of 
time,  these  nerve-impulses  may  become,  acting  as 
masks  to  anatomical  defects,  is  the  object  of  our 
chief  inquiry. 

Eyes  that  perfectly  perform  the  function  of 
vision  may  have  hidden  defects  to  an  alarming 
extent  and  in  proportion  far  greater  than  the 
novice  would  expect.  Some  little  evidence  in 
this  direction  can  be  had  from  the  following  :  I 
do  not  believe  that  full  suspension  of  abnormal 
innervation  takes  place  in  blind  eyes,  but  suspen- 
sion does  to  a  certain  extent.  Through  a  period 
of  many  years,   I  have  been   observing   the   eyes 


RELATION  TO  HEALTH.  71 

of  the  blind  with  the  especial  purpose  of  noting 
their  relative  positions,  and  I  cannot  recall  one 
individual  case  in  which  the  optic  axes  had  not 
deviated  in  some  direction. 

A  similar  condition  of  affairs  exists  in  the 
eyes  of  a  new  born  babe.  One  or  more  mus- 
cles may  be  defective  as  to  length.  Whoever 
has  watched  the  eyes  of  these  little  ones  has 
noted  how  aimlessly  they  wander  about  during 
the  first  few  days,  until  finally  the  stimulus  for 
fusion  causes  them  to  fix  their  vision  ;  and  then 
for  the  first  time,  the  two  eyes  begin  to  look  in 
the  same  direction  and  so  continue. 

"The  eyes  of  new  born  infants  are  almost  in- 
variably hypermetropic."  (Berry.)  This  being 
true,  it  is  the  long  continued  effort  of  the  ciliary 
muscle  that  brings  about  the  emmetropia  of  later 
life,  which  is  so  firmly  fixed,  that  even  mydriat- 
ics sometimes  fail  to  discover  latent  hyperopia. 

In  fourteen  autopsies,  not  one  exception  was 
found  to  the  unequal  development  of  long  mus- 
cles. In  eleven  of  these  cases,  the  superior 
rectus  in  the  right  or  left  eye  was  thin,  tendonous 
and  undeveloped,  giving  evidence  of  having  been 
on  the  stretch,  while  that  of  the  other  eye  was 
invariably  a  well  developed  muscle,  and  the  con- 
verse condition  of  the  inferior  muscle  was  always 
found.  In  two  of  these  eleven,  the  external 
muscles    were    undeveloped,   while    the    internal 


72  THE  EYE  IN  ITS 

showed  X  high  state  of  muscular  development. 
In  one  of  the  remaining  three,  a  habitual  drunkard 
and  suicide,  the  internal  muscles  were  thin  and 
tendonous,  the  externals  being  highly  developed; 
in  the  other  two,  the  externals  were  simply  thin, 
attenuated  tendons,  the  internals  being  highly 
developed.  The  superior  and  inferior  muscles  in 
the  last  three  cases  were  so  poorly  developed 
that  they  gave  no  evidence  of  any  relative  dif- 
ference. A  more  general  inquiry  and  a  larger 
experience  than  I  have  had  the  fortune  to 
acquire  in  examining  the  ocular  muscles  and  the 
positions  of  the  eyes  of  the  dead,  will  bring  out 
much  valuable  evidence  in  this  field  which  as  yet 
is  comparatively  new. 

Look  into  the  dim  windows  of  the  brain 
twenty-four  hours  after  death,  and  a  deviation  of 
the  eyes  from  a  perfect  position  will  always  be 
found.  This  evidence  is  also  against  the  theory 
of  muscular  weakness  or  paresis  as  a  general 
cause  for  the  deviation  of  the  eyes,  for  in  death 
no  innervation  exists,  and  no  relative  strength  or 
weakness.  They  naturally  fall  into  the  positions 
that  the  relative  lengths  permit  them  to  assume. 
Even  then  the  full  defects  do  not  become  mani- 
fest, for  the  long  stretched  muscle  will  yet  be  too 
long  ;  but  all  this  information  comes  too  late  for 
the  life  which  is  ended.  Too  late  for  aught 
but     an     apology    for    perhaps     many    a    cen- 


RELATION  TO  HEALTH.  73 

sured  weakness,  which,  after  all,  was  no  more 
than  the  manifestation  of  some  physical  infirmity 
for  which  the  victim  was  morally  blameless. 
Under  infirmities  thus  insidiously  induced,  but  as 
resistless  as  the  lightning,  a  Dr.  Jekyll  becomes 
a  Mr.  Hyde.  Let  us  judge  justly  of  the  infirmi- 
ties of  man  or  judge  them  not  at  all.  The  ten- 
dency    OF   A     PERFECT     BRAIN     IS     TO    A    PERFECT 

BODY  AND  A  PERFECT  LIFE.  The  perfect  devel- 
opment of  a  brain  or  any  part  may  be  pre- 
vented by  the  existence  of  some  irritant  cause. 
People  with  disagreeable  dispositions  and  habits 
are  not  always  responsible,  as  their  peculiar- 
ities are  possibly  the  result  of  abnormal  nerve- 
impulses  over  which  they  have  no  control ;  and 
such  people  should  excite  our  kindliest  feelings 
rather  than  our  condemnation. 

Several  years  ago  I  was  called  from  a  great 
distance  to  see  a  patient  suffering  from  what  was 
at  times  a  severe  craving  for  alcoholic  stimulus. 
During  this  period  excessive  amounts  of  liquor 
were  drunk,  the  debauch  continuing  about  one 
month.  His  dissipation  was  as  deep  as  possible. 
After  this  followed  the  period  of  sobering.  Then 
for  three  or  four  months  he  would  again  lead  a  per- 
fectly abstemious  life.  He  was  notably  kind  and 
generous  to  the  poor  ;  lent  great  aid  to  moral 
institutions;  was  a  kind,  good  father  and  husband, 
and  seriously  devoted  to  the  church.     It  was  at 


74  THE  EYE  IN  ITS 

the  conclusion  of  one  of  his  sprees  that  I  reached 
his  home  too  late  to  see  him  alive.  On  the  fol- 
lowing day,  the  thought  came  to  me  that  if 
eye-strain  had  had  any  connection  with  his 
infirmity,  it  perhaps  might  manifest  itself  after 
death;  so,  in  the  company  of  his  old  partner 
and  friend,  and  two  undertakers,  I  carefully 
raised  his  eyelids.  The  left  was  fixed  in  a  nor- 
mal position,  the  right  was  turned  upward  fully 
twenty-two  degrees.  Such  evidence  ought  to 
be  a  sufificient  explanation  and  vindication  of 
many  acts  that  may  have  incurred  censure  during 
life. 

The  average  person  of  middle  age  whose  eyes 
are  apparently  perfect,  may  be  seated  behind  an 
8  deg.  prism,  base  down,  when  at  twenty  feet  a 
light  will  appear  as  two  lights,  one  directly  over 
the  other  or  vertical.  According  to  the  prevail- 
ing idea,  this  indicates  that  the  eyes  are  balanced 
as  far  as  the  lateral  or  external  and  internal 
rectus  muscles  are  concerned.  Now,  if  this  bal- 
ance depends  upon  the  anatomical  length  of  the 
muscles,  the  following  test  would  indicate  it;  but 
it  does  not.  I  place  on  the  patient  in  trial  frames, 
say  6  deg.  of  prism,  base  out;  I  direct  the  patient 
to  look  around  the  room  for  a  few  minutes;  I 
now  renew  my  test  with  the  8  deg.  prism,  base 
down,  while  the  6  deg.  prism  is  still  on  the 
patient.      One  of  the  two  lights  still  appears  to  be 


RELATION  TO  HEALTH.  75 

directly  over  the  other.  We  are  now  certain  that 
we  have  6  deg.  of  prism  unaccounted  for  by  the 
test.  Sometimes  we  are  able  to  put  as  high  as 
twenty  or  even  more  degrees  of  prism  over  the 
person's  eyes,  base  in  or  out,  as  just  described, 
and  after  they  have  been  used  for  an  hour,  more 
or  less,  the  two  dots  or  lights  in  the  test  will 
still  appear  to  be  vertical.  If  it  had  been  only 
the  length  of  the  muscles  with  which  we  were 
dealing,  and  the  lateral  muscles  balanced  with- 
out prisms,  when  we  put  on  6  deg.  of  prism,  base 
in  or  base  out,  we  ought  to  have  found  the  dif- 
ference in  length  by  the  irregularity  in  the 
position  of  the  lights;  but  in  such  cases  the  dif- 
ference does  not  appear  in  this  way,  and  such 
experiments  clearly  demonstrate  how  uncertain 
all  diffusion  tests  are.  Long  trained,  and  more 
or  less  fixed  abnormal  nerve-impulses  will  hide 
defects  from  these  tests  that  would  otherwise 
cause  the  eyes  to  deviate  many  degrees. 

Now,  if  this  tendency  to  single  vision  asserts 
itself  with  such  alacrity  and  certainty  under  an 
artificially  created  irregularity,  how  much  more 
would  the  constant  effort  of  years  working  and 
pulling  against  a  muscle  that  is  too  short,  have  a 
tendency  to  hide  the  defect  from  all  diffusion 
tests? 

The  various  disturbances  taking  their  origin  in 
the    visual     nerve-centers  from    eye-strain,    have 


76  THE  EYE  IN  ITS 

been  doing  their  devastating  work,  have  been  gen- 
erating   from   the  very  time   of  birth,    from   the 
very  hour  the  two  eyes  first  began  to  train  together, 
those  conditions  that  are  conducive    to   disease. 
From  that  moment,  nerve-force  waste  and  brain 
irritation  with  its  correlated  consequences  began. 
It  is  true,  in  certain  cases,  that  some  of  the  most 
distressing  symptoms  of  disease  are  often  relieved 
immediately    on    a    correction    of    the    abnormal 
innervation;    but    it    stands    to    reason    that    the 
greater   portion    of    disturbed    conditions,    which 
have  been  so   many   years   in  assuming   definite 
form,  will  require  patience  and  time  for  perfect 
relief.     A  new  established  order  of  things  must 
be  set  up.     The  various  nerve-impulses  that  per- 
form their  characteristic    functions    must    all  be 
changed.     The  centers  that  generate  this    force 
and  the  avenues  they  travel,  must  all  be  differen- 
tiated.    A  new  correlation  has  to  be  established, 
and  sufficiently  long    established    to    maintain  a 
permanency  of  the  new  and  desired  condition  of 
affairs.      If  in    six  months,  a  year  or  more,  the 
impulses  from  the  nerve-centers  have  become  so 
altered  as  to  turn  aside  some  disease  where  death 
was  imminent,  we  can  well  say  that  the  patient 
and  the  physician  have  been  well  rewarded  and 
that  the  time  was  short,  although  the  patience  of 
both  has  been  severely  taxed. 

The  immediate  relief  of  pain  that  sometimes 


RELATION  TO  HEALTH.  77 

follows  the  application  of  glasses  or  operations, 
must  not  be  considered  infallible  indications 
of  a  speedy  cure.  Such  a  relief  is  simply  an 
indication  that  we  are  proceeding  in  the  right 
direction ;  and,  although  a  pain  may  be  stopped, 
or  a  prominent  and  alarming  symptom  subju- 
gated, before  perfect  health  is  restored  there  are 
other  fully  as  important  changes  to  take  place 
which  will  require  a  space  of  months  and  perhaps 
years.  Often  serious  diseases  or  conditions  exist 
that  are  accompanied  by  no  prominent  symptoms 
of  pain ;  nevertheless  they  are  as  emphatically 
threatening  life.  Where  disturbed  brain  centers 
have  been  for  years  furnishing  imperfect  motive- 
force  to  perform  the  various  functions  through- 
out the  body,  the  functions  become  more  or  less 
enfeebled.  Their  structural  assimilation  has  been 
imperfect.  In  such  a  case,  when  pain  is  relieved 
by  a  change  which  we  have  wrought  in  the 
nerve-centers,  we  must  expect  to  wait  some  time 
for  the  permanent  establishment  of  those  motive- 
impulses  that  normally  control  assimilation  and 
organic  functions.  It  takes  time  to  rebuild  that 
which  has  been  many  years  in  breaking  down. 
We  are  apt  to  become  enthusiastic  when  sud- 
denly relieved  of  some  pain  or  alarming  symp- 
tom ;  but  the  process  of  reconstruction  that  fol- 
lows the  new  supply  of  vital  force  is  a  slow  one  ; 
we  are  not  conscious  of  it  from   day  to  day  ;  we 


78  THE  EYE  IN  ITS 

can  realize  it  only  after  a  much  longer  lapse  of 
time.  If  these  changes  are  carefully  noted 
through  periods  of  several  months,  more  or  less, 
we  can  become  calmly  conscious  that  years  will 
be  slowly  added  to  life.  The  good  that  follows 
repression  may  possibly  keep  on  building  up  and 
restoring  for  a  space  of  years.  The  sustaining 
power  of  repression  is  well  established  in  such 
cases  as  Nos.  5,  16  and  17,  pages  95,  113  and 
114. 

In  the  slow  development  of  latent  eye  defects, 
we  learn  how  obstinate  and  unyielding  long  es- 
tablished abnormal  nerve-impulses  are,  how  they 
repeatedly  persist  in  their  endeavor  to  return 
during  development  after  we  have  held  them 
more  or  less  repressed  for  several  months.  We 
have  a  correspondingly  new  state  of  affairs  estab- 
lished, a  changed  condition  of  innervation  which 
is  young,  and  more  or  less  uncertain.  We 
may  be  somewhat  prepared  to  expect  at  times  a 
temporary  return  of  the  old  impulses,  especially 
when  the  nerve-centers  have  been  subjected  to 
exhaustion,  or  when  their  equilibrium  is  disturbed 
by  alcoholic  stimulus,  or  by  an  exhausting 
debauch  in  any  direction.  Under  such  condi- 
tions the  new  ocular  correlation  will  become  tem- 
porarily confused,  which  plainly  indicates  a  need 
of  rest,  but  after  a  time  this  confused  state  ceases 
to  present  itself. 


RELATION  TO  HEALTH.  79 


VII. 


A  SHORT  muscle  on  examination  by  diffu- 
sion tests  may  present  itself  in  four  differ- 
ent ways. 

First.  It  may  be  wholly  manifest,  in  which 
case  any  and  all  tests  will  give  like  results. 

Second.  It  may  be  partly  manifest  and 
partly  latent  to  the  test. 

Third.  //  may  be  absolutely  latent  with  no  man- 
ifest defects. 

Fourth.  Spasm  may  cause  the  eye  to  ?na?iifest 
the  reverse  of  the  a?iatomical  condition,  i?i  which  case 
the  eye  will  deviate  i?i  a  direction  opposite  to  that  of 
the  short  muscle.  This  is  the  dangerous  condition 
that  I  have  elsewhere  pointed  out. 

The  first  four  of  the  following  cases  are  given 
as  illustrations  of  the  four  forms  of  eye-strain, 
respectively. 

Case.  I.  Presented  by  the  president  of  the 
Johnston  Optical  Co.,  of  Detroit.  Left  eye 
turned  upward  20  deg.  above  the  right.  While 
reading,  writing  or  looking  intently  at  any  near 
point,  the  inferior  muscle  of  the  left  eye  drew  it 
down  to  a  level  with  the  other  ;  but  when  not  so 
employed  or  while  looking  off  into  the   distance 


8o  THE  EYE  IN  ITS 

or  holding  ordinary  conversation,  the  nerve-cen- 
ters would  invariably  relax  their  effort  and  the 
eye  would  turn  upward  fully  20  deg.  into  a  posi- 
tion of  perfect  rest  ;  so,  the  greater  part  of  the 
time  there  was  no  strain  in  this  case,  no  constant 
waste  of  nerve-force,  no  unremitting  source  of 
brain  irritation ;  consequently  this  person  suf- 
fered little  or  no  disturbance  of  the  nerve-cen- 
ters. He  was  calm,  quiet,  and  generally  free 
from  ailment.  No  correction  was  made  as 
the  person  felt  no  necessity  for  it. 

The  following  cases  were  treated  by  repres- 
sion. They  are  selected  for  the  purpose  of  set- 
ting forth  some  of  the  most  prominent  features 
of  the  treatment  in  which  tenotomy  and  muscle 
advancement  are  often  necessary.  Sometimes 
the  desired  results  are  arrived  at  without  an  oper- 
ation, the  repression  being  effected  entirely  by 
glasses. 

When  prominent  symptoms  of  a  disease  have 
been  subdued,  we  are  naturally  led  to  believe 
that  our  work  in  repression  is  more  or  less  com- 
plete ;  but  it  has  so  often  proved  incomplete  on 
later  examinations,  that  it  is  never  safe  to  draw 
such  conclusions.  This  will  be  clearly  illustrated 
in  the  following  case  from  Dr.  Stanley  of  Brant- 
ford,  Ont.  In  any  particular  case  treated  by 
repression  alone,  the  only  satisfaction  we  can 
have  is   to  know   that   we   have   proceeded   suffi- 


RELATION  TO  HEALTH.  8 1 

ciently  far  to  establish  a  more  perfect  and  hap- 
pier condition  of  previously   disturbed    functions. 

Case  2.  Partly  manifest;  D.  A.,  age  forty; 
Dr.  Stanley  of  Brantford,  Ont.,  says  this  case  has 
been  under  his  observation  for  upwards  of  four 
years ;  that  from  the  first  it  was  a  very  active  and 
marked  case  of  diabetes  mellitus,  and,  toward  the 
latter  end  of  this  period,  neither  diet  nor  medical 
remedies  seemed  to  make  any  impression  in  less- 
ening the  gravity  or  reducing  the  prominent 
symptoms.  I  saw  the  case  first  on  October  lo, 
1889.  Specific  gravity,  1.052;  thirst  unquench- 
able ;  voided  twenty  pints  of  water  in  twenty-four 
hours ;  sleep  broken  and  restless  ;  obliged  to  get 
up  four  or  five  times  during  the  night  ;  anxiety 
and  general  nervous  symptoms  very  depressing ; 
skin  dry  and  scaly. 

No  hyperopia  was  found  by  dropping  a  two 
grain  solution  of  atropine  into  the  eyes  twice  a 
day  for  one  week ;  then  increasing  to  four  grains 
to  the  ounce,  it  was  used  for  three  days,  and  on 
examining  the  eyes  again  I  still  found  no  indica- 
tion of  hypermetropia.  Vision  without  the  glasses 
was  twenty-twentieths  or  normal.  I  prescribed  a 
+  I  D  glass  for  outdoor  use,  which  gave  twenty- 
fiftieths  of  vision  at  twenty  feet.  For  house, 
reading,  writing  and  all  close  purposes,  I  pre- 
scribed a  +  4  D,  which  was  i  D  more  than  an 
absolute  suspension  of  accommodation  at  thirteen 
5 


82  THE  EYE  IN  ITS 

inches.  This  rendered  the  patient  artificially 
myopic.  At  the  expiration  of  three  months, 
through  the  i  D  glasses  at  twenty  feet,  vision 
was  twenty-twentieths.  On  removing  the  glasses, 
vision  was  also  normal,  but  on  returning  them 
to  the  eyes  again,  the  vision  through  the  glasses 
was  now  reduced  to  twenty-thirtieths,  but  in  half 
an  hour  it  was  again  twenty-twentieths  or  normal. 
I  now  increased  the  power  of  both  pairs  of 
glasses  .75  of  a  dioptre,  which  again  gave  twenty- 
fiftieths  of  vision  at  a  distance,  and  the  glasses 
for  near  use  about  the  same  amount  of  artificial 
myopia  that  the  first  pair  of  reading  glasses  gave. 
At  the  expiration  of  six  months  more,  vision 
under  the  1.75  D,  at  twenty  feet,  was  normal. 
On  removing  these  glasses,  it  now  required  some 
five  minutes  for  normal  vision  to  take  place,  indi- 
cating that  the  reduction  of  ciliary  innervation 
was  becoming  somewhat  fixed.  The  glasses  were 
continued,  as  well  as  the  above  modus  operandi, 
for  a  period  of  one  year,  since  which  time  the 
patient  has  been  wearing  +2.75  for  all  general 
purposes.  With  these  glasses  vision  is  twenty- 
twentieths  at  all  distances,  but  for  the  purpose  of 
resting  the  accommodation,  a  +  5  D  is  frequently 
resorted  to  for  long  and  continued  close  work. 
This  ciliary  repression  was  carried  on  during  the 
treatment  of  the  long  muscles,  which  was  as 
follows  : 


RELATION  TO  HEALTH.  S3 

Created  horizontal  diplopia ;  found  the  supe- 
rior and  inferior  rectus  muscles  balanced.  Ver- 
tical diplopia  disclosed  3  deg.  of  convergence. 
Sufficient  prism  to  make  up  for  the  convergence 
produced  no  change  in  symptoms.  On  the  sup- 
position that  the  manifestation  was  correct,  which 
it  proved  to  be,  and  that  an  unknown  quantity  of 
latent  defect  might  be  in  the  same  direction,  I 
gradually  increased  the  prism,  base  out,  until, 
within  an  hour,  under  30  deg.  of  prism,  the  intol- 
erable thirst  had  entirely  disappeared ;  the  feet, 
which  had  been  constantly  cold,  became  warm ; 
from  a  sallow  paleness  the  complexion  became 
flushed  and  ruddy ;  the  pulse  was  reduced  from 
no  to  'j(^.  The  prisms  were  now  removed.  On 
the  nth,  the  tests  were  repeated  with  similar 
results  as  on  the  previous  day.  On  October  12 
the  patient  could  diverge  for  12  deg.  of  prism, 
base  in.  These  were  kept  on  the  patient  in  this 
position  for  nearly  two  hours.  All  distressing 
symptoms  were  very  much  aggravated  until  the 
patient  exhibited  great  uneasiness  and  alarm. 
The  hands  and  feet  were  cold,  the  complexion 
very  pale,  while  the  pulse  mounted  to  130.  The 
prisms  were  removed,  and  an  unusually  uncom- 
fortable night  followed.  On  the  13th,  30  deg. 
of  prism  were  again  accommodated  for,  and 
worn  for  two  hours.  A  general  relief  followed. 
At  this  time,  the    30  deg.  proving  somewhat  tire- 


84  THE  EYE  IN  ITS 

some  to  the  eyes,  I  reduced  the  prism  to  20  deg., 
which  the  patient  continued  to  wear  for  one  week. 
The  thirst  did  not  return,  the  nights  were  some- 
what more  comfortable,  the  quantity  of  water  re- 
duced to  ten  pints,  while  the  circulation  and 
warmth  in  the  extremities  were  considerably  en- 
hanced. On  now  adding  20  deg.  more  of  prism 
temporarily,  a  perspiration  appeared  on  the  fore- 
head and  other  parts  of  the  body,  the  first  the 
patient  could  remember  having  had  for  nearly 
four  years. 

Partial  tenotomy  was  now  performed  on  each 
internal  rectus  muscle,  leaving  but  a  few  of  the 
outer  fibres.  I  now  had  4  deg.  of  manifest 
divergence,  but  the  symptoms  were  not  so  mate- 
rially relieved  as  they  had  been  under  the  prisms; 
he  could  still  accommodate  for  40  deg.,  base  out. 
Twenty  degrees  were  constantly  worn,  base  out, 
for  two  weeks  following  this,  at  which  time  I 
made  a  complete  division  of  both  internal  tendons, 
not  detaching  them  from  the  capsule.  Under 
diplopia  I  now  had  16  deg.  of  manifest  exophoria. 
Vision  was  single  to  within  a  distance  of  about 
fourteen  inches,  but  diplopia  existed  for  all  dis- 
tances nearer.  The  repression  in  the  external 
muscles  was  now  considerable ;  the  thirst  was 
entirely  gone  and  the  daily  quantity  of  water 
reduced  to  seven  pints;  gravity  1.035;  ^^^^  warm; 
skin  moist ;  cheerfulness  came ;  sleep  more  con- 


RELATION  TO  HEALTH.  85 

tinuous  and  refreshing.  The  gravity  was  reduced 
slowly  and  was  at  times  variable.  On  the  first  of 
May  following,  it  was  1. 020.  On  the  4th  of  July, 
1890,  gravity  was  1.016.  All  tests  now  failed  to 
find  the  slightest  trace  of  sugar.  Repeated  ex- 
aminations at  various  times  through  a  space  of 
four  years  have  resulted  in  finding  no  sugar. 
Perfect  health  has  prevailed.  Patient  paid  me  a 
visit  in  September,  1894,  having  been  through  a 
year  of  tedious  work,  with  some  very  harassing 
reverses.  Was  feeling  somewhat  depressed  and 
nervous;  specific  gravity  1.020;  no  trace  of 
sugar;    no  other  diabetic  symptoms. 

By  diplopia,  the  lateral  eye  muscles  were  per- 
fectly balanced  as  well  as  the  vertical.  By  differ- 
ential test,  namely  prism  base  down  before  one 
eye,  then  the  other,  the  patient  was  able  to 
accommodate  for  several  degrees  more  of  prism 
on  one  eye  than  on  the  other.  I  at  once  began 
repression  in  this  direction,  and  in  one  week  the 
patient  was  wearing  14  deg.  of  prism  base  down 
before  the  right,  or  divided  between  the  two 
eyes,  with  a  perfectly  satisfactory  relief  from 
nervousness  and  depression.  The  color  of  the 
skin  was  very  much  improved. 

To  be  certain  that  these  changes  were  due  to 
the  above  repression  with  the  14  deg.  of  prism,  I 
at  once  reversed  it.  In  the  course  of  two  hours 
the  patient  was  able  to   fuse  for   10  deg.   in  the 


86  THE  EYE  IN  ITS 

opposite  direction.  The  complexion  turned  pale, 
the  pulse  mounted  to  96,  the  hands  and  feet  grew 
cold,  and  a  very  nervous  and  excited  condition 
ensued;  in  ten  hours  the  test  of  the  urine  showed 
sugar;  gravity  1.038.  The  patient  was  very  much 
alarmed.  I  immediately  reversed  the  prisms. 
Nevertheless,  a  restless  night  was  spent.  Gravity 
was  1.030  in  the  morning,  but  by  evening  it  had 
fallen  to  1.020.  On  the  following  day  it  was  1.018 
with  a  perfect  alleviation  of  the  disturbed  con- 
ditions. 

I  now  made  a  complete  division  of  the 
superior  rectus  of  the  right  eye,  not  detaching  it 
from  the  capsule.  This  eye  was  now  thrown 
below  its  fellow  6  deg.,  vision  was  easy  and 
single  with  the  head  slightly  elevated.  On  look- 
ing upward  there  was  double  vision.  At  the  end 
of  three  weeks  no  inconvenience  from  double 
vision  remained  and  the  patient's  condition  was 
in  every  way  satisfactory.  A  letter  was  received 
from  the  patient  seven  months  after  the  last 
operation,  all  conditions  of  health  being  reported 
perfect. 

This  and  many  other  cases  that  can  be  shown 
prove  that,  although  the  prominent  symptoms  of 
disease  may  be  entirely  relieved,  as  this  diabetes 
was  for  a  space  of  over  four  years,  considerable 
abnormal  innervation  may  still  exist.  The  fact  is, 
our  first  operations  relieved  the  nerve-centers  suffi- 


RELATION  TO  HEALTH.  87 

ciently  to  place  the  diabetes  under  subjection;  but 
during  all  this  time  a  considerable  abnormal 
innervation  was  existing.  The  exceeding  promi- 
nence of  the  defect  in  the  lateral  muscles  was 
sufficient  to  hide  completely  that  existing  in  the 
vertical  direction.  It  might  have  been  found 
had  it  been  looked  for  after  the  first  operations, 
but  the  improvement  in  the  general  conditions 
naturally  led  us  to  suppose  that  we  had  done  all 
that  was  necessary. 

I  look  upon  the  above  as  in  no  way  a  stubborn 
case.  The  abnormal  innervations  yielded  very 
readily  to  the  repression.  The  abnormal  inner- 
vation giving  rise  to  tonic  spasm  is  sometimes 
so  stubborn,  that  it  fails  to  yield  at  times,  even 
for  months.  Then  suddenly  it  will  relax  and 
advance  rapidly  into  high  degrees  bringing 
marked  relief.  This  will  be  found  illustrated 
clearly  in  case  No.  19. 

Case  3.  Absolutely  latent;  M.  S.  M.  twenty- 
nine  years  old;  married  ten  years;  highly  intellec- 
tual; graduated  from  a  collegiate  course  at  the 
age  of  eighteen  with  the  highest  honors;  had 
always  been  a  bright,  vivacious  girl,  but  was  of  a 
somewhat  excitable  nature.  Had  always  been 
inclined  to  a  constipated  habit;  at  the  age  of 
twenty-two  began  to  suffer  with  occasional  pains 
and  local  disturbances  in  the  region  of  the  ovaries, 
and  this  condition  continued  to   increase  until  it 


S8  THE  EYE  IN  ITS 

became  an  almost  constant  source  of  suffering. 
At  the  age  of  twenty-seven  other  complications 
set  in,  neuralgic  pains  in  the  upper  portion  of  the 
spine,  also  in  the  dorsal  region.  She  now  had  a 
constant  desire  for  water,  ices,  or  cold  drinks; 
was  voiding  large  quantities  of  water,  being 
obliged  to  get  up  two  or  three  times  in  the  night 
for  that  purpose.  Her  case  was  diagnosed  as 
diabetes  depending  on  chronic  ovaritis,  and  in 
council  a  removal  of  the  ovaries  was  advised. 
Preparations  were  made  for  the  operation,  but, 
through  dread,  it  was  abandoned.  At  about  the 
time  she  visited  me,  she  had  again  decided  to 
undergo  the  operation.  I  found  the  specific 
gravity  of  her  water  1. 044,  eighteen  pints  in 
twenty-four  hours,  perfectly  clear  and  free  from 
color;  thirst  quite  marked;  the  smell  of  acetone 
was  very  perceptible  in  the  breath;  skin  dry  and 
scaly.  She  was  excessivelv  nervous  and  irritable. 
I  created  diplopia  with  prisms  which  at  twenty 
feet  gave  no  indication  of  any  irregularity  in  any 
of  the  eye  muscles;  vision  was  normal  at  both  far 
and  near  points.  Could  converge  for  40  deg.  of 
prism,  and  diverge  the  optic  axes  for  only  6 
deg.  At  the  near  point,  vertical  diplopia  gave  no 
evidence  of  any  irregularity  in  the  lateral  muscles. 
While  under  the  converging  prisms,  base  out, 
her  thirst  and  nervousness  were  aggravated,  so  I 
reversed  the  prisms  to  base  in;  causing  the  eyes  to 


RELATION  TO  HEALTH.  89 

diverge  6  deg.  A  perceptible  relief  followed. 
Founding  my  judgment  on  this  test,  I  now  began 
repression  of  innervation  to  the  internal  muscles, 
by  having  her  wear  6  deg.  of  prism,  base  in,  for 
distance,  and  when  reading  20  deg.,  base  in,  in 
connection  with  a  4-3^  glass  for  suspending  the 
effort  of  accommodation.  The  thirst  was  sub- 
dued almost  at  once,  and  the  nervous  symptoms 
markedly  relieved.  On  the  following  day  she 
was  able  to  wear  8  deg.  of  prism,  base  in,  without 
creating  much  double  vision.  At  the  end  of  one 
month,  by  gradual  repression,  she  was  able  to 
tolerate  20  deg.  of  prism,  base  in,  without  creating 
diplopia.  During  this  repression,  the  pains  in 
neck,  back  and  ovaries  were  greatly  diminished, 
and  the  constipation  was  entirely  relieved  from 
this  time  on. 

On  removing  the  glasses,  I  now  had  a  highly 
manifest  case  of  exophoria.  By  the  finger  test, 
approaching  it  close  between  the  eyes,  I  found 
the  right  eye  less  inclined  to  converge.  I  made  a 
complete  division  of  the  tendon  of  the  external 
muscle  of  the  right  eye  on  the  immediate  line  of 
its  attachment  to  the  sclerotic,  after  which  there 
still  remained  a  manifest  exophoria  of  3  deg.  by 
diffusion  test.  I  continued  repression  in  the  same 
direction,  in  ten  days  again  arriving  at  14  deg.  of 
prism.  I  now  made  a  complete  division  of  the 
tendon  of  the  external  muscle  in  the  left  eye.      In 


90  THE  EYE  IN  ITS 

neither  operation  was  the  tendon  detached  from 
the  capsule.  After  the  last  operation,  all  symp- 
toms were  materially  relieved ;  the  thirst  was 
entirely  gone ;  the  amount  of  water  voided  was 
now  five  pints  with  a  specific  gravity  ranging 
from  1.026  to  1.030;  the  pains  in  the  ovaries,  back 
and  neck  were  gone.  The  only  disagreeable 
feature  to  the  patient  now  was  that  my  last  oper- 
ation had  turned  the  eyes  inward  10  deg.,  and  for 
a  time  all  objects  were  seen  double.  I  now 
placed  on  her  eyes  sufficient  prism,  base  out,  to 
bring  about  single  vision  again.  I  decreased  this 
prism  I  deg.  at  a  time,  varying  through  a  period 
of  two  weeks,  at  which  time  she  was  able  to  see 
objects  properly,  directly  in  front  of  her,  but  on 
turning  the  eyes  either  to  the  right  or  left,  they 
would  again  appear  double. 

I  continued  the  repression  process  by  putting 
on  I  deg.  of  prism,  base  in,  then  two,  letting  her 
wear  each  change  until  fusion  had  taken  place. 
This  I  continued  until  she  was  able  to  accommo- 
date for  8  deg.,  base  in,  which  was  in  about  three 
months  from  the  last  operation.  On  now  remov- 
ing the  prisms,  easy  single  vision  was  possible 
directly  in  front  and  to  both  sides  sufficiently  far 
to  be  perfectly  practicable. 

Six  months  after  the  last  operation,  every  trace 
of  sugar  had  disappeared  from  the  secretions,  the 
quantity  was  normal,  and  not  a  trace  of  ovaritis 


RELATION  TO  HEALTH.  91 

or  spinal  irritation  was  left.     The  general  health 
was  admirable. 

It  is  true  this  patient  was  obliged  to  suffer 
considerable  inconvenience  and  annoyance  during 
the  treatment.  The  double  vision  was  unpleasant 
and  perhaps  alarming  to  the  patient  and  friends, 
but  the  result  far  more  than  counter-balanced  all 
these  trivial  annoyances.  A  dangerous  capital 
operation  was  avoided,  and  health  and  happiness 
restored. 

One  year  after  this  patient  left  my  care,  she 
gave  birth  to  a  healthy  eight  pound  boy.  Three 
years  from  this  time,  although  her  health  had 
remained  perfect,  she  returned  for  an  examination. 
Artificial  diplopia,  both  vertical  and  horizontal, 
disclosed  a  perfect  balance  in  all  the  muscles.  At 
this  examination,  finding  no  functional  derange- 
ments, I  made  no  further  effort  by  repression  to 
discover  if  abnormal  innervation  still  existed. 

Case  4.  Reverse  manifestion  ;  woman,  thirty- 
six  years  old  ;  married  twelve  years  ;  no  children  ; 
when  a  girl  suffered  from  headaches,  with  pain  in 
the  back  of  the  neck  and  between  the  shoulders ; 
since  the  age  of  twenty-two  had  gradually  increas- 
ing sensitiveness  and  pain  in  both  ovaries,  the 
left  being  the  worst ;  habitual  constipation  ;  at  the 
age  of  thirty  kidneys  began  secreting  larger 
amounts  of  water  than  normal ;  at  this  period  a 
gradually   increasing  thirst  set  in  ;  no  sugar  was 


92  THE  EYE  IX  ITS 

ever  discovered  in  the  secretions.  An  operation 
for  the  removal  of  the  ovaries  was  seriously 
advised.  The  patient  was  determined  to  die 
rather  than  submit  to  it. 

Six  months  before  she  visited  me,  an  aggra- 
vating cough  set  in.  At  the  time  of  her  first  visit, 
on  the  twentv-second  of  November,  1892,  the 
amount  of  water  passed  was  twenty-four  pints  in 
twenty-four  hours;  specific  gravity  1.002;  thirst 
insatiable  ;  no  sugar.  Bv  diffusion  test  the  supe- 
rior and  inferior  muscles  were  apparently  balanced, 
the  external  and  internal  muscles  turned  the  eyes 
inward  4  deg.  I  corrected  this  by  placing  4  deg. 
of  prism,  base  out,  on  the  patient.  In  an  hour  the 
prism  test  again  showed  2  deg.  more  of  conver- 
gence. I  corrected  this  ;  in  half  an  hour,  under  6 
deg.  of  prism,  base  out,  there  were  2  deg.  more  of 
manifest  convergence.  Instead  of  balancing  this 
with  prisms,  I  overcorrected  bv  24  deg.  Within 
an  hour  all  distressing  symptoms  were  very  much 
aggravated,  especiallv  the  pain  and  thirst.  I  con- 
cluded from  this  that  the  manifest  convergence 
was  due  to  spasm  and  that  the  prism  was  increas- 
ing it.  I  now  removed  the  glasses.  After  twenty 
minutes  the  patient  was  able  to  accommodate  for 
4  deg.  of  prism,  base  in;  in  half  an  hour  2  deg. 
more  were  tolerated,  increasing  the  divergence  of 
the  eves.  The  thirst  and  pain  were  somewhat 
relieved.      I    now  put   on   the   patient    10   deg.  of 


RELATION  TO  HEALTH.  93 

prism,  base  in,  and  sent  her  home  for  the  night. 
This  gave  double  vision  for  any  distance  beyond 
ten  feet. 

November  twenty-third.  At  noon  the  patient 
was  able  to  see  objects  single  under  the  10  deg. 
prisms.  I  now  tested  with  prisms  at  the  near 
point,  12  inches,  at  which  distance  12  deg.  more 
of  divergence  were  manifested,  which  made  in  all 
22  deg.  at  the  near  point.  I  now  suspended 
accommodation  with  a  4-3  D  glass,  and  overcor- 
rected  the  entire  amount  of  divergence  manifested 
at  the  near  point  by  putting  on  28  deg.  of  prism, 
directing  the  patient  to  continue  reading  as  long 
as  possible.  In  a  quarter  of  an  hour  the  mouth 
had  become  moist,  the  thirst  had  entirely  disap- 
peared, and  the  pain  in  the  ovaries  was  gone. 
The  distance  prisms  were  increased  to  12  deg.  and 
the  repression  kept  up  at  both  far  and  near  points 
for  three  days.  The  improved  conditions  contin- 
ued. This  decided  the  patient  to  undergo  what- 
ever temporary  inconveniences  were  necessary  to 
this  treatment.  On  the  twenty-sixth  of  November 
I  made  a  complete  division  of  the  tendon  of  the 
external  muscle,  not  separating  it  from  the  cap- 
sule. Three  days  later  a  division  of  the  opposite 
tendon  was  made.  The  result  was  16  deg.  of 
manifest  convergence.  Double  vision  existed  at 
all  points  beyond  twenty  inches.  Vision  was  now 
made  single  by  8   deg.  of  prism,  base  out.     This 


94  THE  EYE  IN  ITS 

was  reduced  almost  daily.  At  the  expiration  of 
ten  days,  vision  without  glasses  was  single, 
directly  in  front,  but  double  on  looking  either  to 
the  right  or  left.  Repression  was  continued  with 
prisms,  base  in,  increasing  them  one  degree  at 
a  time,  through  a  period  of  three  months,  when 
14  deg.  of  prism  were  worn,  base  in,  with  single 
vision  for  all  distances.  The  amount  of  water 
was  now  reduced  to  five  and  one-fourth  pints  in 
twenty-four  hours.  The  most  rapid  reduction  was 
during  the  first  few  days  of  treatment.  The  only 
ovarian  diflficulty  now  left  was,  that,  when  the 
patient  was  lying  on  her  back,  she  could  not 
straighten  her  left  limb  without  producing  a  slight 
pain  in  the  left  ovary. 

SuflRcient  divergence  had  taken  place,  so  that 
I  now  advanced  or  shortened  the  internal  muscle 
of  the  right  eye  sufficiently  to  give  1 2  deg.  of  con- 
vergence again.  Repression  was  continued.  At 
the  end  of  three  months,  vision  was  single  with- 
out glasses.  This  convergence  would  have  cor- 
rected itself  in  time  without  the  use  of  prisms 
but  not  so  quickly. 

I  have  seen  the  patient  occasionally  through 
the  space  of  nearly  two  years,  and  not  a  trace  of 
the  old   difficulty  has  ever  returned   in  that  time. 

Ignorant  criticism  of  this  class  of  cases, 
where  diplopia  or  double  vision  has  been  created 
for  the    purpose    of    reversing   or    repressing  an 


RELATION  TO  HEALTH.  95 

abnormal  nerve-impulse,  has  proved  very  injuri- 
ous to  a  large  class  of  sufferers,  in  many  in- 
stances costing  life ;  a  criticism  that  is  conscien- 
tious, no  doubt,  as  many  see  no  deeper  into  the 
necessities  of  the  eyes  than  that  their  muscles 
should  bear  a  perfect  balance  physically ;  but 
such  critics  do  not  seem  to  know  that  physical 
balance  is  often  sustained  by  an  alarming  degree 
of  unbalance  or  inequality  of  nerve  currents,  that 
is  destroying  the  equilibrium  of  the  brain  centers, 
and  fast  robbing  them  of  vital  forces  that  should 
be  expended  in  other  directions.  As  it  is  the 
abnormal  impulse  alone  that  is  sapping  life  of  its 
forces,  that  is  disturbing  the  brain,  we  must  look 
sufficiently  deep  to  discover  this  disturbing  force, 
and,  when  necessary,  temporarily  sacrifice  the 
apparent  muscular  balance,  which,  under  proper 
care,  rights  itself  in  from  a  few  days  to  a  few 
months.  Discontinuance  of  the  treatment  in 
obedience  to  this  criticism  has  often  resulted 
fatally  to  the  patient  in  a  very  few  days.  The 
great  daiiger  lies  ifi  the  eyes  remaini?ig  in  that  abnor- 
mally balanced  co7iditio?i  that  is  threatening  life. 
The  following  cases,  Nos.  5,  6  and  7,  are  illus- 
trative of  this  statement : 

Case  5.  June,  1890,  Mr.  McL.,  of  Windsor, 
Ont.,  aged  forty-six,  was  voiding  eighteen  pints  of 
water  in  twenty-four  hours;  specific  gravity  1.044; 
thirst  intense,  with  symptoms  of  portal  congestion; 


96  THE  EYE  IN  ITS 

an  appearance  of  excessive  jaundice ;  very  ner- 
vous; pulse  115  ;  chronic  diarrhoea.  After  deter- 
mining that  the  external  muscles  were  short,  and 
that  considerable  strain  existed  in  the  ciliary  mus- 
cles, I  began  repression  by  relaxing  one  of  the 
external  muscles,  and  putting  on  heavy  fogs  at 
once  (+5  D).  In  three  days  time  the  eighteen 
pints  of  water  were  reduced  to  six;  the  thirst  was 
entirely  relieved  ;  the  Jaundice  color  of  the  com- 
plexion had  cleared  ;  much  relief  was  experienced 
as  to  the  portal  congestion ;  and  the  diarrhoea 
was  relieved  as  well  as  the  indigestion.  The 
patient  was  able  to  walk  but  a  few  rods  when  I 
first  saw  him.  By  the  end  of  one  week  he  was 
able  to  walk  two  miles  without  experiencing  any 
inconvenience.  On  the  tenth  day  the  specific 
gravity  was  i  .032  and  the  patient  had  so  gained 
in  strength  that  he  was  able  to  walk  four  miles 
without  fatigue.  This  was  the  last  visit  he  made ; 
for,  in  his  weak  mental  state,  he  was  led  to  be- 
lieve that  the  changes  he  had  experienced  could 
not  be  the  result  of  anything  that  had  been  done 
to  the  eyes.  By  advice,  that  which  I  had  done 
was  undone ;  the  glasses  were  removed,  and 
superseded  by  a  prescription  of  opium  and  atro- 
pine. The  condition  of  the  patient  grew  rapidly 
worse,  and  on  the  twenty-eighth  day  after  I  last 
saw  him  he  died. 

Case  6.     August    15,    1890;  Mr.    R.,  of    De- 


RELATION  TO  HEALTH.  97 

troit ;  age  thirty-five ;  clerk  in  clothing  store ; 
had  suffered  for  past  two  years  from  excessive 
melancholia ;  he  was  nervous,  irritable  and  his 
nights  restless ;  was  habitually  constipated ;  six 
months  before  visiting  me,  he  began  to  notice 
considerable  difficulty  in  walking,  especially  in 
the  dark,  with  a  gradual  and  partial  loss  of  feel- 
ing in  the  lower  limbs ;  symptoms  of  motor- 
ataxy  developed  rapidly.  On  his  first  visit  he 
was  unable  to  turn  around  quickly,  while  walk- 
ing, without  great  danger  of  falling;  was  unable 
to  stand  with  his  eyes  closed ;  complexion  pale, 
feet  and  hands  cold.  I  began  repression  with 
prisms  and  plus  spherical  glasses.  During  the 
first  day,  considerable  warmth  was  restored  to 
the  extremities  and  a  ruddier  color  to  the  skin. 
At  the  end  of  three  weeks  he  had  so  improved 
that  he  was  able  to  stand,  without  falling,  while 
his  eyes  were  closed.  There  was  some  improve- 
ment in  the  walk ;  he  was  now  able  to  turn 
around  with  much  less  clumsiness.  The  im- 
provement in  this  case  was  very  considerable  for 
the  space  of  two  months,  at  which  time  Mr.  R. 
felt  able  to  return  to  his  duties  in  the  clothing 
store,  which  had  been  abandoned  for  three 
months  previous  to  the  treatment. 

The    repression    glasses    were    somewhat  dis- 
agreeable, and  during  my  absence   in  the   East, 
Mr.  R.  was  induced  to  abandon  them  and  try  a 
7 


98  THE  EYE  IN  ITS 

treatment  that  consisted  of  suspension.  From 
this  time  his  condition  grew  worse,  and  at  the  end 
of  three  months  he  put  a  period  to  his  existence 
by  shooting  himself. 

Case  No.  7.  F.  G.  age  thirty-five;  bright, 
intelligent  and  for  several  years  actively  engaged 
in  business;  suffered  occasionally  from  ver- 
tigo and  extreme  nervousness.  A  few  weeks 
previous  to  coming  to  me,  on  returning  to  his 
home  one  evening  he  was  seized  with  dizziness, 
temporary  partial  loss  of  vision,  and  was  pros- 
trated for  several  weeks,  being  confined  to  bed. 
It  was  now  first  discovered  that  he  was  suffering 
from  diabetes.  His  devoted  brother,  who  had 
been  a  patient  under  this  treatment,  went  to  visit 
him,  and  by  slow  stages  and  resting,  brought  him 
to  me.  I  found  his  specific  gravity  1.050;  four- 
teen pints  of  water  in  twenty-four  hours;  thirst 
intense;  pulse  105;  unable  to  walk  but  a  few  rods, 
and  that  with  great  exhaustion.  Repression 
rapidly  subdued  his  thirst;  reduced  his  gravity  in 
two  months  to  1.024;  his  pulse  to  75.  In  three 
months  he  had  gained  fourteen  pounds  in  weight 
and  enjoyed  a  walk  of  two  or  three  miles.  He 
returned  to  his  home  two  thousand  miles  away. 
Ciliary  repression  was  continued  by  a  high  grade 
of  fogging.  During  a  space  of  four  months  very 
bright  and  encouraging  letters  concerning  his 
health  were  received.      Riding,   driving  and  fish- 


RELATION  TO  HEALTH.  99 

ing  excursions  were  indulged  in  with  great 
pleasure.  He  wrote  a  letter  telling  that  he  had 
been  able  to  dance  eight  round  dances  in  a  night. 
This,  of  course,  I  at  once  advised  against.  A  few 
days  after  this  he  had  the  misfortune  to  have  all 
his  glasses  broken,  and  neglected  for  three  weeks 
to  have  them  replaced,  at  the  end  of  which  time 
he  was  suddenly  taken  ill  again.  Hurried  corre- 
spondence by  his  sister  followed,  asking  for 
glasses.  Then  came  a  telegram  that  he  was 
much  worse,  and  the  following  day  another 
announcing  his  death.  This  and  the  two  pre- 
vious cases  are  three  only  of  many  similar  ones 
that  I  have  known.  The  uplifting  and  sustain- 
ing power  of  repression  is  as  clearly  demonstrated 
in  these,  as  in  that  class  of  cases  that  have 
resulted  favorably. 

I  do  not  assume  that  cases  Nos.  5,  6  and  7, 
which  resulted  fatally,  would  have  been  cured 
had  they  continued  treatment ;  but  as  far  as  the 
treatment  was  carried,  the  evidence  was  most 
markedly  in  its  favor. 

Where  defects  exist  in  several  of  the  muscles, 
the  defect  is  sometimes  so  prominent  in  one  as  to 
hide  completely  the  defects  in  the  others,  which 
only  manifest  themselves  to  us  after  a  correction 
of  the  first.  The  reasons  for  this  will  be  discussed 
at  more  length  after  clinics 

Case  8.     J.  A.  age  twenty-four;  farmer;  had 


lOO  THE  EYE  IN  ITS 

suffered  from  epileptic  seizures  since  sixteen 
years  of  age,  which  gradually  increased  in  fre- 
quency until  they  were  of  daily  occurrence;  the 
mental  faculties  were  very  much  impaired;  the 
power  of  speech  was  affected  to  the  extent  that 
it  was  very  difficult  to  understand  the  patient;  the 
right  upper  and  lower  extremities  were  partially 
paralyzed,  so  that  his  walk  consisted  of  a  dragging, 
halty  gait,  while  the  right  hand  and  arm  were 
used  but  little,  and  clumsily;  constipated  habit, 
and  complexion  pale. 

Vertical  and  horizontal  diplopia  disclosed  no 
muscle  defect;  convergence  was  45  deg. ;  diver- 
gence 2  deg.  After  a  careful  examination  lasting 
three  days,  I  began  repression  with  prism,  base 
down,  before  the  left  eye,  which,  when  forced  to 
8  deg.,  led  to  an  improvement  in  the  color  of  the 
skin  and  the  action  of  the  heart,  diminishing  its 
activity  from  95  to  75  beats  per  minute,  with  a 
feeling  of  warmth  and  tingling  to  the  right  hand 
and  foot.  Several  tests  were  made  by  removing 
the  prism  and  reversing  its  position,  in  which  case 
the  above  symptoms  were  increased.  From  these 
indications,  I  now  crowded  the  prism  to  14  deg., 
base  down,  before  the  left  eye.  Twice  I  was 
obliged  to  reduce  the  prism  2  or  3  deg.  to  prevent 
diplopia,  from  the  spasms  that  would  ensue.  The 
epileptic  seizures  were  now  reduced  to  one-third 
in  number,  also  much  in  severity.      I  now  made  a 


RELATION  TO  HEALTH.  lOl 

complete  division  of  the  superior  rectus  muscle  of 
the  left  eye.  The  cut  eye  assumed  a  normal 
position.  The  opposite  eye  turned  upward  i8 
deg.  It  required  12  deg.  of  prism  to  bring  about 
fusion.  I  began  reducing  this,  degree  by  degree, 
but  the  opposite  eye  was  very  slow  and  obstinate 
in  getting  back  into  line.  At  the  end  of  six 
weeks,  not  having  accomplished  this,  but  still 
retaining  single  vision  with  prisms,  I  again  exam- 
ined the  lateral  muscles  with  the  same  result  as  at 
first,  2  deg.  of  divergence  and  45  deg.  of  conver- 
gence with  this  difference;  vertical  diplopia  now 
indicated  5  deg.  of  convergence.  I  now  added 
prism,  base  out,  to  correct  this,  and  exceeded  the 
correction  by  putting  on  the  patient  24  deg.  of 
prism,  which  were  worn  for  three  hours  in  my 
office,  during  which  time  the  face  became  pale, 
the  hand  and  foot  cold,  followed  by  a  fit  of  con- 
siderable severity  which  lasted  five  minutes.  This 
decided  me  that  the  present  manifest  convergence 
was  due  to  spasm ;  so,  on  the  following  day,  I 
began  repression  at  the  near  point,  suspending 
accommodation  with  a  fog,  or  -I-4D  glass,  and  20 
deg.  of  prism,  base  in,  diverging  the  eyes.  In 
two  hours  4  deg.  of  prism,  base  in,  could  be  tol- 
erated with  single  distant  vision.  I  added  a  -|-iD 
glass  reducing  the  distant  vision  to  twenty-fiftieths. 
At  the  end  of  ten  days  the  patient  was  wearing 
12  deg.  of  prism,  base  in;  the  vertical  displace- 


I02  THE  EYE  IN  ITS 

ment  that  resulted  from  the  operation  had 
corrected  itself;  the  eye  had  come  down  into  line 
while  I  was  diverging  the  eyes  and  repressing  the 
REVERSE  MANIFEST  defect  in  the  lateral  muscles. 
From  this  time  on  all  conditions  improved 
rapidlv.  The  power  of  speech  returned;  no  fits 
have  occurred  since,  with  the  exception  of  occa- 
sional petit-mal.  At  the  end  of  one  month,  20 
deg.,  base  in,  were  tolerated  with  single  vision.  I 
now  advanced  the  internal  rectus  of  the  right  eye. 
When  last  heard  from,  the  patient  had  passed  one 
year  of  perfect  health,  during  which  time  the 
ciliary  had  been  kept  under  a  repression  of  a 
+2D  glass  for  general  purposes,  with  reading 
glasses  +3D  stronger. 

Had  this  patient  abandoned  treatment  after 
the  first  operation,  which  I  had  to  use  persua- 
sion to  prevent  his  doing,  he  undoubtedly  would 
have  suffered  the  inconvenience  of  double  vision 
for  a  considerable  length  of  time,  as  the  result  of 
a  want  of  correction  in  the  second  defect. 

Case  9.  Paralysis.  Mr.  E.,  aged  sixty-five, 
passed  an  active  business  life  up  to  sixty  years  of 
age,  when  he  first  began  to  experience  restless 
nights  with  little  sleep ;  a  growing  irritability 
with  occasional  attacks  of  dizziness ;  several 
months  of  each  year  were  spent  at  health  resorts 
and  watering  places  with  some  little  improvement 
at  first ;  but,   on  returning  to   business,  the  dis- 


RELATION  TO  HEALTH.  103 

turbed  conditions  would  return  after  two  or  three 
weeks.  For  one  year  a  dull  pain  was  constant 
about  the  base  of  the  brain.  On  January  15, 
1872,  while  sitting  at  breakfast,  he  was  stricken 
with  apoplexy  and  was  unconscious  for  twenty- 
four  hours.  The  next  day  on  returning  to  con- 
ciousness,  it  was  discovered  that  he  had  partially 
lost  the  power  of  speech  and  the  use  of  the  right 
upper  and  lower  extremities.  After  three  weeks 
he  was  able  to  limp  about  with  the  help  of  an  as- 
sistant. The  vertigo  was  excessive ;  there  was  a 
constant  dread  of  some  impending  evil ;  the 
memory  and  reasoning  faculties  were  much  im- 
paired. With  varying  conditions  of  health,  the 
paralysis  still  remaining,  he  visited  me  in  1892 
when  his  condition  was  rapidly  growing  worse. 
In  this  weakened  and  depressed  condition,  as  is 
usually  the  case,  the  irregularities  in  the  ocular 
apparatus  were  very  manifest.  A  short  under 
muscle  in  the  right  eye  and  inner  muscle  in  the 
left  were  found,  with  one  dioptre  of  manifest 
hyperopia.  Repression  in  all  three  muscles  was 
begun  at  once.  At  the  end  of  the  second  day 
there  was  a  marked  change  for  the  better ;  the 
internal  rectus  now  was  detached.  Immediately 
after  this  operation,  the  patient  noted  a  percepti- 
ble improvement  in  the  return  of  a  natural  feeling 
to  the  paralyzed  side;  no  inconvenience  resulted; 
his  speech  was  very  much   improved.     The    re- 


I04  THE  EYE  IN  ITS 

pression  was  continued,  and  in  two  weeks  from 
this,  he  was  wearing  with  perfect  ease  and  single 
vision,  14  deg.  of  prism,  base  down,  before  the 
right  eye.  The  impediment  in  the  speech  was 
now  entirely  gone,  also  the  spells  of  dizziness  ; 
the  feeling  of  fright  passed  away,  and  in  one 
month  from  the  first,  his  visits  were  made  without 
the  necessity  of  having  an  attendant  with  him  ; 
and  w^ere  continued  for  the  space  of  two  months. 
From  this  time  on,  his  circulation  was  good ;  his 
bowels,  which  had  been  previously  constipated, 
were  now  regular ;  he  acknowledged  that  he  felt 
better  than  he  had  felt  for  ten  years.  During 
the  space  of  over  one  year  he  has  attended,  with- 
out the  slightest  inconvenience,  to  whatever  busi- 
ness he  has  had  to  do ;  he  eats  and  sleeps  well, 
and  says  that  he  enjoys  every  moment  of  his 
life. 

Case  10.  Consumption.  In  1873,  in  company 
with  my  father  and  Dr.  Goodrich,  of  Bellevue, 
Ohio,  I  visited  Mrs.  S.  on  a  farm  in  Huron  coun- 
ty ;  she  had  suffered  for  a  year  and  a  half  with 
consumption ;  in  the  six  months  previous  to  my 
seeing  her,  she  had  had  two  hemorrhages  ;  the 
afternoon  fever  and  night  sweats  had  been  very 
persistent  for  seven  months.  Little  or  nothing 
was  hoped  for  in  her  case  ;  her  principal  treat- 
ment had  been  hypophosphites  and  cod  liver  oil, 
alternated    each   week   with    large   doses  of  rich 


RELATION  TO  HEALTH.  105 

cream.  Incidentally,  during  this  visit,  Mrs.  S. 
asked  if  her  left  eye,  which  was  very  much 
turned  inward,  could  be  straightened.  I  told  her 
I  thought  so,  and  a  few  days  later  it  was  operated 
upon.  An  over-correction  of  several  degrees  re- 
sulted from  the  operation ;  of  course  this  was  not 
sought  for,  but  it  established  a  repressive  strain. 
I  paid  two  visits  after  the  operation,  after  which  I 
did  not  see  the  patient,  as  she  moved  to  Hazelton, 
Pa.  Two  years  passed,  when  one  day  the  hus- 
band of  Mrs.  S.  walked  into  my  office.  He 
talked  with  me  some  five  minutes  without  refer- 
ring to  his  wife,  who  I  felt  confident  was  long 
since  dead.  He  said,  "You  don't  ask  me  about 
Mrs.  S."  I  said,  "I  did  not  wish  to  distress 
you.  I  suppose  she  is  no  longer  with  you  ?"  He 
said  ** That's  just  where  you  are  mistaken;  she  is 
perfectly  well  and  hearty  and  weighs  nearly  two 
hundred  pounds."  He  reported  that  a  few 
months  after  I  last  saw  her,  her  cough  ceased 
and  her  health  began  rapidly  to  improve.  This 
case  was  not  operated  on  with  the  expectation  of 
influencing  the  diseased  condition  of  the  lungs, 
but  later  experience  has  caused  it  to  be  recalled 
to  my  memory  as  a  result  possibly  due  to  the 
radical  change  in  the  nerve-centers  resulting  from 
the  repression  established  by  the  operation. 

Case  II.    Woman;  age  twenty-two;  consump- 
tion ;  constipated  habit ;  complexion  pale ;  pulse 


lo6  THE  EYE  IN  ITS 

85  in  the  morning,  in  the  afternoon  and  evening 
120,  with  a  hectic  fever  which  had  existed  about 
ten  months ;  bright  red  spots  about  the  size  of  a 
penny  on  both  cheeks ;  nights  restless,  and  for  the 
past  six  weeks  night  sweats  were  profuse ;  lower 
lobe  of  left  lung  congested  and  dull  on  percus- 
sion ;  cough  quite  severe ;  no  hemorrhage.  Ex- 
amined this  case  in  the  morning;  pulse  85. 
Repression  was  made  with  prisms  by  turning  left 
eye  up  12  deg.  In  thirty  minutes  the  pulse  was 
reduced  to  64.  To  this  prism  was  added  ciliary 
repression  reducing  distant  vision  to  twenty-fif- 
tieths. The  next  morning  better  conditions  were 
reported  for  the  previous  afternoon  and  night ; 
pulse  was  now  76.  Repression  was  now  made  at 
the  near  point  by  forcing  the  eyes  outward  24 
deg.,  and  foggmgwith  a  -f-5  D  spherical.  Patient 
looked  at  pictures  in  a  book  for  half  an  hour ; 
had  great  difficulty  to  avoid  going  to  sleep  while 
sitting  in  the  chair ;  pulse  reduced  to  64 ;  a 
healthy,  red  glow  covered  the  entire  face,  ears 
and  neck ;  the  hands  and  feet  grew  warm.  Pa- 
tient now  wore  away  -[-  3  D  spherical,  14  deg.  of 
prism,  base  down,  before  the  left  eye,  combined 
with  18  deg.,  base  in.  Repression  was  being  made 
in  three  directions.  From  this  time  on,  there  was 
no  more  hectic  fever,  flush,  or  night  sweats  ;  at 
the  end  of  two  weeks  from  the  first  visit,  the  cough 
had    entirely    ceased ;    the    only    symptom    that 


RELATION  TO  HEALTH.  107 

remained  was  dullness  on  percussion  of  the  lower 
lobe  of  the  left  lung.  At  the  end  of  one  month 
eight  pounds  had  been  gained.  At  this  period  a 
very  serious  interference  with  the  treatment 
occurred.  The  patient's  sister  was  taken  ill.  She 
watched  by  her  bedside  constantly  for  eight  days, 
when  the  sister  died.  This,  of  course,  told  heav- 
ily against  any  further  advancement  in  the  case, 
but  none  of  the  old  symptoms  returned.  On  the 
day  of  the  funeral,  from  over-exhaustion  and 
grief,  the  nerve-centers  were  so  disturbed,  that  I 
was  obliged  to  reduce  my  prism  6  deg.  in  various 
directions  to  still  maintain  fusion.  After  she  had 
had  a  few  days'  rest  I  increased  the  prism  to  its 
former  standard.  Two  weeks  after  burying  her 
sister,  she  was  wearing  18  deg.,  base  in.  I  now 
advanced  the  right  internal  muscle,  leaving  10 
deg.  of  convergence,  which  in  ten  days  had 
entirely  disappeared.  I  now  advanced  the  infe- 
rior rectus  of  the  left  eye,  bringing  it  6  deg.  below 
its  mate.  A  slight  vertical  diplopia  existed  after 
this  operation,  but  in  three  weeks  it  had  entirely 
disappeared.  At  the  expiration  of  six  months 
the  patient  had  gained  twelve  pounds  and  her 
health  in  every  way  was  perfect. 

Case  12.  Male;  age  twenty-five;  acute  con- 
sumption ;  was  constipated ;  anaemic ;  had  cold 
hands  and  feet ;  weight  one  hundred  and  nine 
pounds ;  pulse  90  in  the  morning,  in  the  evening 


io8  THE  EYE  IN  ITS 

115;  night  sweats  had  been  continuous  for  two 
months  previous  to  the  first  visit ;  a  severe  cough 
had  existed  for  five  months,  and  the  expectoration 
was  a  thick  mucus ;  the  sputa  was  not  examined 
microscopically  ;  there  had  been  no  hemorrhages  ; 
the  left  lung  was  dull  on  percussion  and  its  breath- 
ing space  limited,  especially  in  the  lower  lobe. 
The  diagnosis  of  consumption  in  this  case  was 
based  on  the  evidence  of  the  above  symptoms 
without  the  microscopic  examination  of  the  sputa, 
the  occurrence  of  a  hemorrhage,  or  any  apparent 
disintegration,  but  all  of  the  other  symptoms  were 
well  marked. 

The  treatment  consisted  of  repression  of  the 
ciliary  with  +5  D  glasses,  which  were  worn  most 
of  the  time ;  2  D  were  permitted  for  outdoor  pur- 
poses for  limited  periods.  These  gave  but 
twenty  one-hundredths  of  vision ;  repression  also 
of  both  external  and  left  inferior  rectus  muscles. 
The  complexion  at  once  changed  from  a  pale  to 
a  pink  color ;  the  hands  and  feet  were  warmer. 
At  the  end  of  two  weeks  the  patient  was  wearing 
16  deg.  of  prism,  base  down,  before  the  left  eye, 
which  was  repressing  the  innervation  to  the  infe- 
rior rectus  muscle.  A  division  of  the  superior 
muscle  of  this  eye  was  made  at  the  end  of  two 
weeks.  The  cough  ceased  at  once ;  constipation 
was  now  relieved,  and  the  heart's  action  reduced 
to  70.      Repression  in  the  ciliary  and  both  exter- 


RELATION  TO  HEALTH.  109 

nals  was  continued  with  glasses  for  two  weeks 
longer.  I  now  made  a  complete  division  of  the 
right  internal  and  advanced  the  left  external,  by 
my  operation  of  a  single  stitch  and  a  ligature 
plate,  thus  bringing  about  10  deg.  of  divergence 
by  diffusion  test.  One  month  after  the  last  oper- 
ation there  still  remained  3  deg.  of  divergence, 
while  the  vertical  muscles  were  balanced. 

This  case  was  heard  from  seven  months  after 
the  last  operation.  The  general  health  was  much 
improved ;  none  of  the  old  symptoms  remained ; 
eighteen  pounds  in  weight  had  been  gained. 

Case  13  was  the  mother  of  the  above  patient, 
who  accompanied  him  during  his  treatment ;  her 
age  was  forty-four ;  had  suffered  from  chronic 
bronchitis  for  five  years ;  was  of  slight  build  ; 
anaemic ;  had  suffered  much  from  headaches  and 
spinal  irritation ;  had  cold  hands  and  feet ;  pulse 
was  normal.  Ciliary  repression  was  made  with 
glasses  that  gave  twenty-fiftieths  of  vision.  Re- 
pression of  the  right  inferior  rectus  was  continued 
for  one  month,  when  she  was  wearing  22  deg.  of 
prism,  base  down,  before  the  right  eye.  Complete 
division  of  the  tendon  of  the  superior  rectus  was 
now  made.  The  cough  ceased  the  first  day ;  the 
hands  and  feet  were  warmer;  the  general  circula- 
tion was  much  improved ;  the  headaches  and 
spinal  irritation  were  entirely  relieved.  This  case 
was  also  heard  from  seven  months  after  leaving, 


no  THE  EYE  IN  ITS 

when  the  health  was  reported  good,  with  a  gain 
of  eleven  pounds  in  weight. 

Case  14.  Male;  age  forty-one;  symptoms 
of  consumption  fourteen  months ;  pale,  very 
nervous  and  restless ;  occasional  pains  in  left 
lung ;  lower  and  middle  lobe  dull ;  occasional 
night  sweats ;  hectic  fever  in  the  evening  accom- 
panied by  an  excessive  sensitiveness  of  the  entire 
right  side  of  the  face,  also  of  the  cheek  inside  the 
mouth  ;  no  inflammatory  action  existed  in  these 
parts  ;  cold  water  had  to  be  drunk  with  great  care 
to  prevent  its  coming  in  contact  with  the  right 
side  of  the  mouth,  in  which  case  it  gave  rise  to 
distressing  pain ;  right  side  of  face  could  not  be 
touched  with  a  feather  or  even  a  hair  without 
giving  rise  to  great  distress  and  alarm.  This 
patient  had  been  advised  to  have  the  facial 
nerves  cut  out  to  relieve  the  painful  sensitiveness. 
The  case  yielded  slowly  to  repression ;  at  the 
end  of  six  weeks  the  left  eye  had  turned  upward 
15  deg.;  at  this  time  +3  D  glasses  gave  twenty- 
thirtieths  of  vision.  I  did  not  fog  the  vision  to 
the  same  extent  in  this  case,  because  I  needed  a 
higher  acuity  to  assist  in  the  repression  in  a  ver- 
tical direction.  There  was  some  general  im- 
provement in  all  the  conditions  of  the  patient  up 
to  this  time.  I  now  advanced  the  inferior  rectus 
of  the  left  eve,  using  mv  ligature  plate,  which 
drew  it  6  deg.  below  its   fellow  by  diffusion  test, 


RELATION  TO  HEALTH.  m 

but  double  vision  did  not  result.  The  sensitive- 
ness in  the  face  and  inside  of  the  cheek  entirely 
disappeared  within  three  days.  Repression  in 
the  ciliary  was  now  increased  by  fogging  the  pa- 
tient to  twenty-sixtieths  for  distant  vision,  adding 
-|-3  D  more  for  reading  purposes,  so  as  to  sus- 
pend entirely  the  action  of  the  ciliary  for  the 
time  being  ;  the  constipation  was  entirely  relieved 
from  this  time ;  the  cough  ceased,  and  in  five 
months  this  patient  had  gained  thirty  pounds  in 
weight ;  pulse  70 ;  appetite  and  complexion 
good.  Perfectly  good  health  continued  for  a  lit- 
tle over  one  year,  since  which  time  I  have  not 
heard  from  the  patient. 

Consumption.  I  have  made  preliminary  ex- 
aminations and  repression  tests  in  one  hundred 
and  twelve  cases  of  consumption,  and  in  all  with 
the  exception  of  nine,  some  of  which  might  have 
yielded  by  longer  persistence  in  the  tests,  I  was 
able  to  bring  about  marked  changes  in  the  prom- 
inent symptoms,  generally  consisting  of  a  reduc- 
tion of  the  high  action  of  the  heart,  change  in 
the  color  of  the  skin,  increase  in  the  warmth  of 
the  hands  and  feet,  where  the  extremities  had 
been  cold.  None  of  these  cases  were  treated 
further  than  a  few  preliminary  tests.  In  such 
cases  there  is  a  great  lack  of  patience  to  under- 
go the  repression ;  but  this  is  quite  natural  to 
nervous  persons,  inasmuch  as  they  generally  lack 


112  THE  EYE  IN  ITS 

confidence  in  the  possibility  to  affect  lung  dis- 
eases through  the  visual  centers.  Consumption 
is  most  markedly  a  nervous  disease.  Its  pre- 
monitory stage  is  marked  by  nervous  conditions 
which,  emphasized  in  character,  accompany  it 
through  all  its  stages.  F.  J.  McGillicuddy,  A.M., 
M.D.,  of  New  York,  says,  ** Tubercular  consump- 
tion is  not  a  local  but  a  constitutional  disease, 
and  calls  for  general  treatment.  Tubercular 
bacilli  do  not  and  cannot  cause  consumption  in  a 
perfectly  healthy  individual.  They  only  induce 
disease  in  persons  with  lowered  vitality,  who  thus 
become  susceptible'  to  their  influences."  I  am 
thoroughly  convinced  that  a  large  percentage  of 
consumption  takes  its  origin  from  irritation  aris- 
ing through  the  visual  centers,  and  that  many 
cases,  especially  in  their  earlier  stages,  are  amen- 
able to  treatment  through  the  same  medium. 

Case  15.  Mr.  F.;  age  sixty;  delicate  habit; 
constipated ;  very  nervous  ;  at  the  age  of  twenty 
was  attacked  with  paralysis  agitans,  or  shaking 
palsy,  which  lasted  through  a  space  of  forty 
years.  At  the  time  I  saw  the  patient  his  trouble 
was  complicated  with  chronic  bronchitis,  sciatica 
and  spasmodic  stricture  of  the  neck  of  the  blad- 
der. Repression  of  the  ciliary  and  inferior  mus- 
cle of  the  right  eye  with  glasses  brought  some 
alleviation  of  the  shaking.  A  complete  division 
of  the    superior    rectus    was    made,   after  which, 


RELATION  TO  HEALTH.  113 

while  my  hand  was  still  resting  on  the  forehead, 
I  noticed  the  shaking  suddenly  cease.  The  pa- 
tient turned  pale,  was  nauseated.  He  said,  "I 
feel  strange ;  I  think  my  shaking  is  over."  The 
spasm  at  the  neck  of  the  bladder  also  passed 
away  at  once,  doing  away  with  the  necessity  of 
using  a  catheter  which  had  been  required  for  the 
past  three  years  in  voiding  the  urine.  I  heard 
from  this  case  occasionally  for  two  years.  The 
constipation,  sciatica  and  chronic  bronchitis  were 
very  much  reduced,  and  there  had  not  been  any 
return  of  the  shaking  palsy  or  of  the  irritation  of 
the  bladder. 

Case  16.  Gen.  C.  of  the  United  States  Vol- 
unteers; age  sixty;  dyspeptic;  much  depressed;  in 
weak  and  rapidly  failing  condition;  progressive 
atrophy  of  the  optic  nerves  had  gradually 
destroyed  the  vision,  until  barely  enough  sight 
was  left  to  enable  him  to  get  about  the  streets; 
he  could  recognize  friends  only  by  the  sound  of 
the  voice;  could  not  read;  would  write  from  habit 
but  could  not  see  what  he  wrote;  vision  was  so 
imperfect  in  this  case  that  I  could  utilize  but  little 
fusion  power  in  repression.  It  was  three  months 
before  I  arrived  at  a  conclusion,  at  which  time  I 
made  a  complete  division  of  the  right  internal 
rectus  muscle.  There  was  an  immediate  improve- 
ment in  the  general  feelings,  and  in  three  months 
from  this  time  the  patient  had  gained  twenty- 
8 


114  THE  EYE  IN  ITS 

eight  pounds  in  weight,  and  was  able  to  read 
ordinary  newspaper  print,  which  I  advised  him  to 
do  sparingly.  One  year  later  distant  vision  was 
normal;  general  health  and  appearance  were 
excellent. 

The  following  case  that  resulted  fatally  is 
evidence  by  no  means  adverse  to  the  value  of 
this  treatment.  The  patient  was  in  a  very  critical 
state  at  the  time  treatment  was  commenced,  and 
the  result  verifies  the  sustaining  or  supporting 
power  of  repression  during  the  time  it  was  con- 
tinued. 

Case  17.  H.  H.,  age  fifty;  diabetes  mellitus; 
gravity  1.048;  quantity  sixteen  pints  in  twenty- 
four  hours;  intense  thirst;  very  weak;  unable  to 
walk  but  a  few  rods;  repression  with  prisms  and 
by  fogging  vision  to  the  possibility  of  reading 
ordinary  type  not  farther  than  twelve  inches, 
removed  the  thirst,  and  in  three  weeks  reduced 
the  specific  gravity  to  1.030  and  the  quantity  to 
seven  pints  in  twenty-four  hours;  heart's  action 
was  reduced  from  100  to  75.  These  conditions 
were  maintained  with  but  little  change  for  the 
space  of  three  months,  with  the  exception  that  the 
gravity  occasionally  fell  to  nearly  normal,  1.022, 
and  again  went  up  to  1.030.  The  uncertainty  of 
further  results  and  the  tediousness  of  the  fogging 
process,  were  the  cause  of  the  patient's  abandon- 
ing treatment  at  this  point,  removing  the  glasses 


RELATION  TO  HEALTH.  115 

and  resorting  to  water  cure  treatment.  A  week 
after  the  glasses  were  discarded  the  bad  symp- 
toms had  all  returned,  and  in  three  weeks  the 
patient  was  dead. 

Case  18.  H.  H.,  girl;  age  ten;  nervous,  mis- 
chievous, playful  child;  after  receiving  slight 
chastisement  from  her  teacher  had  a  severe 
attack  of  St.  Vitus's  dance,  which  lasted  for  three 
months.  This  was  followed  by  complete  paraly- 
sis of  the  right  side,  and  of  the  power  of  speech; 
the  mental  faculties  became  a  perfect  blank;  the 
child's  attention  could  not  be  attracted  in  any 
way,  she  would  not  even  look  up  on  being 
repeatedly  called  by  her  name;  parents  were 
obliged  to  feed  her  by  putting  food  into  her 
mouth.  The  left  eye  was  partially  blind;  this 
was  determined  by  covering  the  right,  when  the 
child  would  make  an  effort  to  uncover  it;  but  she 
paid  no  attention  when  the  left  was  covered. 
Under  the  influence  of  chloroform  administered 
at  three  different  times,  a  manifest  defect  in  the 
superior  and  internal  muscles  of  the  left  eye  was 
very  apparent.  Under  the  existing  conditions,  I 
could  only  approximate  the  defects.  A  com- 
plete division  of  the  internal  rectus  was  made  on 
this  diagnosis.  Plus  3D  glasses  for  repressing 
any  possible  ciliary  strain  were  tolerated  by  the 
child,  but  any  stronger  than  these  were  rejected. 

In  two  months  she  was  able  to  walk,   consider- 


ii6  THE  EYE  IN  ITS 

able  impediment  yet  being  noticeable  in  her 
speech,  but  her  mental  faculties  were  in  every 
way  very  much  improved.  In  examinations  of 
the  eyes,  she  was  now  able  to  answer  questions. 
Repression  was  commenced  by  forcing  the  left 
eye  upward  with  prism.  More  improvement  in 
the  use  of  the  paralyzed  extremities  was  noticed. 
A  division  of  the  superior  rectus  of  this  eye 
was  made.  In  four  weeks  from  this  time,  the 
child  was  able  to  walk  with  a  somewhat  halting 
gait,  and  use  the  right  hand.  In  eight  months 
from  the  time  I  first  saw  the  patient,  not  a  trace  of 
the  difficulty  was  left.  The  child  was  now  witty, 
intelligent,  active,  and  desired  to  return  to 
school.  I  advised  her  not  to  do  so.  After 
a  lapse  of  two  years  I  saw  this  little  patient 
again,  and  in  perfect  health  which  had  continued 
since  the  treatment.  Two  years  later,  making  in 
in  all  four,  I  received  a  letter  from  her  father 
stating  that  her  general  conditions  of  health  were 
excellent. 

Case  19.  Male;  age  thirty-five;  was  a  bright 
and  promising  youth,  quick  to  learn  and  more 
than  ordinarily  ambitious.  He  was  eccentric,  his 
disposition  and  habit  being  so  changed  at  times 
that  they  might  belong  to  another  person.  At 
the  age  of  twenty-five,  he  was  actively  engaged 
in  a  successful  business,  and  from  this  time  these 
changes    of    disposition    grew    gradually    more 


RELATION  TO  HEALTH.  117 

marked.  His  choice  of  friends  and  associates 
was  usually  fastidious  ;  but  every  three  or  four 
months  a  period  of  two  or  three  weeks  would  in- 
tervene, in  which  all  his  leisure  hours  would  be 
spent  in  neighborhoods  strange  to  his  former  as- 
sociations, and  among  people  of  the  coarsest  type. 
These  periodical  changes  of  disposition  and  asso- 
ciation were  as  marked  and  regular  as  the  sprees 
of  a  periodic  drunkard.  Through  a  general  in- 
creasing nervous  debility  he,  at  the  age  of  thirty- 
two,  was  thoroughly  incapacitated  for  work,  and 
the  business  passed  into  the  hands  of  another 
member  of  the  family.  He  was  now  unable  to 
carry  on  a  coherent  correspondence.  His  mem- 
ory was  very  much  impaired ;  he  was  unable  to 
fasten  his  mind  upon  either  book  or  newspaper ; 
and,  if  he  tried,  a  moment  afterwards  forgot  what- 
ever he  may  have  read.  At  times  he  was  morose 
and  surly,  and  would  be  dangerous  to  cross. 
Again,  being  very  sympathetic,  he  would  break 
down  in  a  child-like  way,  and  from  some  imagin- 
ary cause  would  be  moved  to  tears.  Again  his 
ambitious  side  would  return  and  he  would  specu- 
late in  ridiculously  impossible  schemes.  Through 
incompatibility  his  wife  now  deserted  him  ;  con- 
sequently his  disturbed  mental  symptoms  were 
rapidly  and  greatly  emphasized,  and  at  the  age  of 
thirty-three  he  was  placed  in  an  asvlum.  From 
this  time  his  scheming  and  eccentric  ambitions 


Ii8  THE  EYE  IN  ITS 

ceased.  For  the  next  two  years  despondency 
was  the  marked  feature  of  his  condition,  occa- 
sionally alternated  by  spells  of  pitiful  repining 
and  regret. 

It  was  in  this  condition  that  he  was  brought 
to  me  by  his  mother.  The  only  notable  local 
symptoms  were  a  pale  complexion  and  a  heart's 
action  of  96.  It  required  fully  an  hour  of  care- 
ful handling  on  my  part  before  I  gained  his 
confidence  and  secured  his  attention  sufficiently 
to  proceed  with  an  examination ;  but  he  gradually 
grew  very  much  interested,  and  was  no  longer 
disposed  to  interfere  with  my  tests.  Refraction 
in  both  eyes  at  the  far  point  was  above  normal, 
twenty-fifteenths.  It  was  perfect  at  the  near 
point.  By  diffusion  test,  far  point,  prism  base 
down  before  the  left  eye,  the  upper  dot  or  light 
was  2  deg.  to  the  left.  With  prism  base  in  the 
left  light  was  the  lower,  manifesting  a  left  hyper- 
phoria of  ^  deg.  in  conjunction  with  a  manifest 
esophoria  of  2  deg.  at  the  far  and  near  points. 
Two  degrees,  base  down,  before  either  eye  created 
diplopia.  Could  fuse  i  deg.  before  either  eye,  but 
with  my  vertical  chart,  using  a  2  deg.  prism,  base 
down,  before  the  left,  there  were  two  dots  2  deg. 
apart,  while  2  deg.,  base  down,  before  the  right 
separated  the  dots  or  lights  i  J^  deg.  from  each 
other.  I  now  placed  before  his  right  eye  i  deg. 
of  prism,  base  down.     After  a  few  minutes  vision 


RELATION  TO  HEALTH.  119 

seemed  sharper.  This  was  shortly  increased  to  2 
deg.,  and  within  half  an  hour  to  3  deg.  Pulse 
was  not  materially  changed.  Even  with  repeated 
efforts  the  next  half  hour  I  failed  to  increase  the 
prism.  The  countenance  was  somewhat  flushed 
and  a  violent  headache  followed,  which  was  some- 
thing from  which  he  had  never  suffered  before. 
The  prisms  were  removed  and  tests  continued  the 
following  day.  The  next  day  I  commenced  with 
I  deg.,  base  down,  before  the  left,  the  reverse  of 
the  previous  day's  treatment.  In  an  hour  he  had 
accepted  5  degs.  of  prism  in  this  direction,  the 
complexion  was  paler  and  the  heart's  action  had 
mounted  to  124,  with  an  increase  of  nervous 
symptoms.  I  now  changed  the  position  of  the 
prisms  to  the  same  that  it  had  been  during  the 
first  day's  test,  base  down  before  the  right  eye. 
In  another  half  hour  he  was  able  to  fuse  for  4 
deg.  of  prism.  The  pulse  was  reduced  to  86,  and 
the  skin  became  somewhat  flushed.  Headache 
again  returned  and  the  test  was  abandoned  for 
the  day. 

As  to  symptoms,  base  down  before  the  right 
diminished  somewhat  the  excitability  of  the 
heart  and  improved  the  color  of  the  skin,  while 
at  the  same  time  it  brought  on  severe  headache. 
With  prism  in  the  opposite  direction  the  heart's 
excitability  was  much  increased,  the  complexion 
paler,  and  the  nervousness  visibly  aggravated. 


I20  THE  EYE  IN  ITS 

On  the  following  day  I  chose  that  position 
which  improved  the  heart's  action  and  the  color 
of  the  skin.  Four  degrees,  base  down,  before  the 
right  was  all  he  could  fuse  under.  He  was 
allowed  to  wear  this  home  the  remainder  of  the 
day.  His  night's  rest  was  slightly  improved. 
During  the  next  test,  he  was  able  to  fuse  for  6 
deg.  of  prism.  The  glasses  were  comfortable 
during  the  day,  and  the  vision  remained  single 
until  just  before  bedtime,  when  headache  again  set 
in.  On  awaking  in  the  morning,  he  was  unable 
to  fuse  for  his  6  deg.  of  prism,  and  after  having 
spent  a  restless  night  he  returned  to  my  office 
without  the  glasses.  His  eyes  now  manifested 
the  reverse  of  every  previous  condition  ;  the  right 
eye  appeared  to  be  the  lower  of  the  two.  This  I 
suspected  to  be  due  to  spasm,  owing  to  a  bad 
night's  rest.  I  proceeded,  degree  by  degree,  to 
coax  the  eyes  to  fuse  under  prism,  base  down, 
before  the  right.  I  was  unable  to  succeed  with 
more  than  3  deg.,  which  I  left  on  the  patient. 

On  awaking  in  the  morning  he  was  able  to  fuse 
for  the  3  deg.,  and  came  to  my  office  wearing  the 
glasses.  He  now  succeeded  in  fusing  for  7  deg. 
early  in  the  morning.  He  wore  the  prisms  all 
day  with  comfort  and  some  little  improvement  in 
feelings,  his  heart's  action  being  reduced  to  80. 

On  the  following  morning  his  eyes  would  not 
fuse   for   7   deg.,  but  by  my  orders  he  kept  the 


RELATION  TO  HEALTH.  121 

glasses  on  until  he  arrived  at  the  office.  I  did 
not  remove  them,  but  suspended  the  ciliary  accom- 
modation with  a  -j-3  D  spherical  glass.  Fusion 
at  the  near  point  took  place  at  once.  After  read- 
ing a  short  time  and  having  the  sphericals 
removed,  he  was  able  to  fuse  for  all  distances. 
These  glasses  were  continued  during  the  day. 
The  night's  rest  was  much  improved.  When  he 
put  on  the  glasses  after  awaking  in  the  morning 
vision  was  double,  but  after  half  an  hour  fusion 
had  taken  place.  Complexion  was  decidedly  bet- 
ter and  the  heart's  action  the  same,  80.  At  pres- 
ent, prism  could  not  be  increased  above  7  deg. 
I  now  suspended  accommodation  with  -j-3  D 
spherical  glasses,  and  at  the  near  point  was  able 
to  increase  my  prism  3  deg.  more.  After  he  had 
looked  at  pictures  for  half  an  hour,  the  pulse  was 
reduced  to  76,  and  the  face  was  quite  flushed, 
with  some  little  nausea.  The  following  day  the 
same  was  repeated  without  the  nausea.  I  now 
increased  the  glasses  to  -I-5  D.  Buzzing  in  the 
ears  shortly  followed  this,  dizziness,  nausea  and 
profuse  perspiration  ;  pulse  reduced  to  70.  I  now 
suspected  that  the  ciliary  had  suddenly  relaxed 
its  tonic  innervation  and  on  examination,  found 
his  vision  normal  with  a  -f-1.50  spherical  glass  in 
connection  with  the  7  deg.  of  prism,  base  down, 
before  the  right  eye.  He  now  manifested  3  deg. 
of  exophoria,  instead  of  2  deg.  of  esophoria  which 


122  THE  EYE  IN  ITS 

had  showed  on  the  first  examination.  At  the  near 
point  the  exophoria  was  i8  deg.,  whereas  the  first 
examination  gave  2  deg.  in  the  opposite  direction. 
The  correlation  that  had  existed  under  abnormal 
conditions  was  now  practically  broken  down,  and 
a  partial  manifestation  of  the  actual  state  of 
the  muscles  presented  itself.  Plus  2  D  spherical 
glasses  and  7  deg.  prisms  were  worn  until  bed 
time,  which  was  an  hour  earlier  than  usual,  and 
he  slept  ten  continuous  hours,  the  longest  period 
of  rest  that  he  could  remember  for  many  years. 
On  the  following  morning  his  eyes  accepted  the 
7  deg.  of  prism  but  rejected  the  spherical  glasses  ; 
everything  seeming  exceedingly  foggy  and  dim 
through  them.  The  ciliary  spasm  had  returned. 
The  long  night's  rest  had  recuperated  the  nerve- 
centers,  and  thev  refused  to  yield  to  the  same 
conditions  that  had  controlled  them  on  the  pre- 
vious day.  I  now  increased  to  10  deg.  of  prism, 
base  down,  before  the  right,  a  -f5  D  spherical, 
and  18  deg.  of  prism,  base  in,  because  of  the  fact 
that,  in  the  relaxed  condition  of  the  previous  day, 
he  had  manifested  this  amount  of  exophoria  at 
the  near  point.  Under  this  combination,  even  at 
the  near  point,  some  considerable  difficulty  was 
experienced  in  inducing  the  eyes  to  fuse.  After 
they  had  fused,  reading  was  continued  for  half  an 
hour,  when  the  nausea  and  profuse  perspiration 
again  set  in.     The  patient  was  induced  to  tolerate 


RELATION  TO  HEALTH,  123 

the  glasses  and  these  discomforts  for  half  an  hour 
longer,  when  the  pulse  had  fallen  to  62.  The 
patient  now  returned  home  with  three  pairs  of 
glasses,  7  deg.,  base  down,  before  the  right  eye, 
18  deg.,  base  in,  with  -\-2  D  spherical  glasses. 
Nine  hours  of  continuous  sleep  followed.  In  the 
morning  his  eyes  fused  under  the  7  deg.,  base 
down,  but  again  rejected  both  other  pairs.  It 
would  be  needless  to  detail  this  case  further. 
The  process  of  discovering  the  abnormal  innerva- 
tions that  had  maintained  a  perfect  correlation  in 
the  action  of  the  two  eyes,  had  now  revealed  the 
defects,  while  the  mental  condition  of  the  patient 
showed  marked  signs  of  improvernent.  Changes 
in  the  manifestation  of  the  eye  defects  continued 
from  day  to  day  to  reveal  and  again  hide  them- 
selves until,  at  the  end  of  one  month,  the  patient 
was  wearing  before  the  right  eye  20  deg.  of 
prism,  base  down,  and  20  deg.  of  prism,  base  in.  I 
now  made  a  complete  detachment  of  the  superior 
tendon  of  the  right  eye,  dropping  the  eye  6  deg.  be- 
low its  mate.  At  this  time  I  had  the  patient  wear- 
ing 20  deg.  of  prism,  base  in,  with  4-2.50  spherical 
glasses,  which  gave  normal  vision.  The  complexion 
from  now  remained  good,  and  the  pulse  was 
never  found  above  72.  Two  weeks  after  the  first 
operation  the  left  external  tendon  was  completely 
detached,  producing  8  deg.  of  esophoria  by  diffu- 
sion test,  but  lights  fused  without  prism.      Repres- 


124  THE  EYE  IX  ITS 

sion  with  prisms,  base  in,  was  continued  for  three 
weeks,  when  i6  deg.  could  again  be  tolerated 
without  double  vision.  I  now  completely  detached 
the  external  tendon  of  the  right  eye.  Under 
diffusion  test,  there  were  now  i6  deg.  of  conver- 
gence and  an  inability  to  maintain  single  vision 
farther  than  fifteen  inches.  Plus  2.50  D  spheri- 
cals  were  continued  with  6  deg.  of  prism,  base 
out,  to  bring  about  fusion  for  distance.  This  was 
reduced  slowly  from  day  to  day  and,  in  three 
months  from  the  last  operation,  no  double  vision 
existed. 

The  patient's  mental  condition  was  now  en- 
tirely relieved.  He  seemed  happy,  would  smile, 
laugh  at  anything  funny,  and  seemed  fond  of  tell- 
ing wittv  anecdotes.  The  only  abnormal  condi- 
tion that  now  existed  was  that,  on  looking  to  the 
extreme  right  or  left,  double  vision  would  occur. 
I  deemed  it  advisable  to  keep  the  distance  vision 
at  twenty-fortieths,  thus  continuing  a  slight  ciliary 
repression. 

I  have  occasionally  seen  this  patient  during  the 
space  of  two  years.  His  mental  condition  has 
continued  very  satisfactorv ;  none  of  the  eccen- 
tricities of  his  earlier  life  have  recurred  ;  his  whole 
character  seems  changed ;  he  is  of  a  quiet,  happy 
disposition,  and  attends  to  whatever  business  he 
has  to  do  without  worry. 

One  year  after  the   first   operation   a   perfect 


RELATION  TO  HEALTH.  125 

balance  existed  in  all  ocular  muscles  under  diffu- 
sion tests.  He  fused  for  4  deg.  of  prism,  base 
down,  before  either  eye,  6  deg.,  base  in,  and  45 
deg.,  base  out.  A  new  and  perfect  correlation 
had  been  established. 

Case  20.     Mrs.   H.,  Joliet,   111.     This  patient 
was  brought  to  my  office  by  Dr.  Orin  W.  Moon,  of 
Lockport,  111.     She  says  she  has  suffered  for  the 
past  ten  years  from  female  weakness  consisting  of 
chronic  inflammation  and  neuralgia  of  the  ovaries; 
severe    headache    preceding    and    through    the 
menstrual  period;  has  always  been  of  a  delicate 
habit;  catarrh  of  the  throat,  eustachian  tube  and 
internal  ear  has  been  increasing  for  the  past  ten 
years  with  a  gradual  loss  of  hearing;   for  the  past 
two  years   the   right   ear   has    been    totally   deaf 
while  the  left  could  distinguish  loud  conversation 
only   at   a    close    distance.      Has    taken    various 
remedies  almost  continuously   for  the    past    ten 
years.       The    catarrhal    difficulty    and    deafness 
were    treated    locally,     the    treatment    including 
dilatation  with  the  Pulitzer  bag  and  catheter. 

Vertical  muscles  apparently  balanced;  5  deg. 
of  convergence  at  the  far  point;  esophoria  at  the 
near  point,  thirteen  inches;  at  the  start  I  fortun- 
ately suspected  this  to  be  a  case  of  reverse 
manifestation.  I  suspended  ciliary  strain  with  a 
-f5D  glass,  and  with  30  deg.  of  prism,  base  in, 
found  that  the    patient    could    fuse    at  the   near 


126  THE  EYE  IN  ITS 

point.  I  directed  her  to  read  in  the  above  com- 
bination, and  in  ten  minutes  she  could  hear  a  faint 
whisper  in  the  left  ear  and  ordinary  conversation 
in  the  right.  By  repression  I  developed  exo- 
phoria  of  20  deg.  at  the  far  point,  and  on  the 
fourth  day  made  a  complete  division  of  the  ten- 
don of  the  external  rectus  of  the  left  eye.  All  of 
the  previous  disturbances  were  at  once  relieved; 
within  one  month  the  catarrh  had  disappeared; 
all  sensitiveness  and  neuralgia  in  the  ovaries  were 
now  gone,  and  for  the  first  time  in  her  life  the 
monthly  sickness  came  and  passed  without  the 
slightest  headache  or  local  disturbance.  In 
every  way  the  general  health  has  been  much 
improved  and  the  patient  says  she  feels  perfectly 
well. 

I  do  not  present  this  case  as  an  ordinary  one, 
but  because  it  is  one  of  the  quickest  and  most 
remarkable  cures  in  the  history  of  my  practice. 

The  following  tabulated  list  of  clinics  has  been 
selected  from  a  large  number  of  cases  for  the 
express  purpose  of  showing  what  class  of  cases  have 
yielded  and  may  possibly  yield  to  repression 
treatment.  Failures  in  about  the  proportion 
noted  in  the  preceding  detailed  clinics  could  be 
shown.  A  report  of  adverse  results  would  be  of 
no  value  as  it  is  the  object  of  this  work  to  show 
what  can  be  accomplished  through  the  visual 
centers.     The  failures  are  due  to  several  causes, 


RELATION  TO  HEALTH. 


27 


especially  neglect  to  follow  treatment,  and  to  the 
fact  that  some  cases  are  beyond  or  outside  of  its 
influence 


Ovaritis  with  general  fe- 
male weakness       -     - 

Prostatitis  with  inflamma- 
tion of  the  neck  of  the 
bladder       

Insanity     ----- 

Uric  Acid  Diathesis,  rheu- 
matism and  general  ner- 
vous debility  -     -     -     - 

Chronic  Rheumatism 

Asthma 

Insanity 

Diabetes  Mellitus     -     - 
Paralysis  hemiplegia    - 
Motor  Ataxy  -     -     -     - 
Prostatitis  and  irritation  of 

the  bladder      -     - 
Rheumatism  -     - 
Consumption      -  _   - 
Consumption     with 

vous  debility     - 
Ovaritis    -     -     -     - 


Hay  Fever      .... 
Heart    disease  functional. 
Glaucoma 


Nystagmus     -     -     -     . 
Heart  disease  functional 
Prostatitis        -     -     .     . 
Rheumatism       -     -     - 
Diabetes  insipidus    -     - 


Ataxy  -  -  ■ 
Bright's  disease 
Ovaritis   •     -     • 


Q  W 
til  -) 

PERIOD 

H  0 

DURA- 

OF 

TION. 

TREAT- 

s« 

MENT. 

2  0 

M. 

syrs. 

F. 

38 

3mos. 

M. 

12  " 

M. 

S8 

I  mo. 

M. 

5" 

M. 

50 

8mos. 

M. 

8" 

F. 

S^ 

2mos. 

S. 

10  " 

M. 

48 

4mos. 

s. 

20  " 

F. 

SI 

I  mo. 

M. 

5" 

F. 

32 

7mos. 

S. 

4" 

M. 

40 

lyr. 

M. 

12  " 

M. 

ss 

I  yr. 

S. 

3" 

M. 

38 

Smos. 

S. 

12  " 

M. 

so 

Smos. 

M. 

8" 

F. 

.ss 

6mos. 

S. 

1  " 

F. 

22 

8mos. 

s. 

15" 

M. 

2S 

8mos. 

M. 

8" 

F. 

26 

3mos. 

M. 

10  " 

M. 

34 

3mos. 

s. 

5  " 

F. 

16 

3  mos. 

M. 

5" 

M. 

53 

4mos. 

S. 

20" 

M. 

28 

I  mo. 

S. 

3  " 

F. 

22 

6wks. 

M. 

20  " 

M. 

6S 

I  mo. 

M. 

15" 

F. 

S8 

I  yr. 

M. 

3" 

F. 

37 

8  mos. 

S. 

I  " 

M. 

32 

3  mos. 

s. 

2  '• 

F. 

40 

4  mos. 

M. 

6" 

F. 

30 

2  mos. 

Cured. 


Cured. 
Cured. 


Cured. 

Very  much  re- 
lieved. 
Cured. 
Cured. 
Cured. 
Cured. 
Much  improved. 

Cured. 
Cured. 
Cured. 

Cured. 

Cured;  was  pre- 
viously barren ; 
had  a  healthy 
babe  i  yr.  after 
treatment 

Cured. 

Cured. 

Cured;  one  eye 
was  blind  at 
beginning  of 
treatment. 

Cured. 

Cured. 

Cuied. 

Cured. 

Cured;  was  pre- 
viously barren : 
gave  birth  to  a 
healthy  babe  18 
months  after 
treatment. 

Much   improved. 

Cured. 

Cured,previously 
barren  ;i8  mos. 
after  treatment 
gave  birth  to  a 
healthy     babe. 


128 


THE  EYE  IX  ITS 


2  3 

PERIOD 

DISEASE. 

I'i 

<  w 

S  5 

DURA- 
TION. 

SEX. 

AGE 

OF 
TREAT- 
MENT. 

RESULT. 

Anaemia  and  general  ner- 

vous debility     -     -     - 

M. 

loyrs. 

F. 

32 

4  mos. 

Cured;  previous- 
ly barren;  had 
babe   10    mos. 
aftertreatment. 

Insane  and  paralyzed  -     - 

S. 

6  mo. 

F. 

H 

9  mos. 

Cured. 

Prostatitis  and  irritation  of 

the  bladder-     -     -     - 

M. 

loyrs. 

M. 

68 

I  mo. 

Cured. 

Cirrhosis  of  the  liver    -     - 

M. 

12" 

M. 

45 

4  mos. 

Cured,     has    re- 
mained      per- 
fectly well  for 
two  years. 

Melancholia  and  sterilitj' 

M. 

8" 

F. 

37 

lyr. 

Cured ;        gave 
birth     to    babe 
10  months  after 
treatment. 

Constipation  and  nervous 

debility 

S. 

12  " 

M. 

27 

6  mos. 

Cured. 

Insanity 

M. 

8" 

F. 

51 

omos. 

Cured. 

Chorea 

S. 

2  " 

F. 

12  ;  3  wks. 

Cured. 

Diabetes  mellitus    -     -     - 

M. 

I  " 

M. 

49  '  9  mos. 

Cured. 

Shaking  Palsy     -     -     - 

M. 

lO  " 

M. 

60     I  mo. 

Cured. 

Rheumatism,  chronic  -     - 

M. 

9" 

F. 

63     7  mos. 

Cured. 

Melancholia,          constant 

dread       

S. 

6" 

M. 

41     6  mos. 

Cured. 

Diabetes  mellitus    -     -     - 

M. 

I  " 

M. 

49  ;  9  mos. 

Cured. 

Shaking  Palsy     -     -     - 

M. 

ID  " 

M. 

60     I  mo. 

Cured. 

Rheumatism,  chronic  -     - 

M. 

9" 

F. 

63     7  mos. 

Cured. 

Melancholia,          constant 

dread       

S. 

6" 

M. 

41 

6  mos. 

Cured. 

Asthma 

S. 

12  " 

F. 

28 

2  mos. 

Cured. 

Prostatitis       ...     - 

M. 

9  " 

M. 

50 

6  mos. 

Cured. 

Ovaritis,  sterility    -     -     - 

M. 

9" 

F. 

26     5  mos. 

Cured;  had  heal- 

thy     babe      9 

mos. after  treat- 

ment. 

Chronic  ulcerative  catarrh 

M. 

6" 

F. 

43 

8  mos. 

Cured ;  had  been 
pronounced  and 
treated  as  syph- 
ilitic catarrh. 

Hay  fever       .     -     -     - 

M. 

12  " 

F. 

36 

I  mo. 

Cured. 

Motor  Ataxy       -     -     -     - 

S. 

5" 

M. 

45 

4  mos. 

Much    improved 
in  every  way. 

Constipation  and  dyspep- 

sia       

M. 

50" 

F. 

72 

2  mos. 

Cured. 

Sciatica     and      uric     acid 

diathesis 

M. 

15  " 

M. 

65  !  6  mos. 

Cured. 

Hay  fever 

S. 

6" 

M. 

51  1  3  mos. 

Cured. 

Consumption      -     -     -     - 

M. 

18  mo. 

M. 

45  i  7  mos. 

Cured. 

Diabetes  insipidus    -     - 

M. 

2  " 

M. 

43  1  I  mo. 

Cured. 

Shaking  Palsy   -     -     .     - 

S. 

5" 

M. 

65 

3  mos. 

Cured. 

RELATION  TO  HEALTH.  129 


VIII. 

T  T  /"HEN  the  optic  axes  deviate  or  have  a 
'  ^  tendency  so  to  do,  the  fault  has  com- 
monly been  attributed  to  muscular  weakness 
or  paresis.  If  the  left  eye  deviated  above  its 
mate,  this  theory  assumed  that  the  inferior  mus- 
cle of  that  eye  was  insufficient  in  strength  to 
hold  it  down.  If  it  deviated  inward,  the  outer 
muscle  was  said  to  be  too  weak ;  if  outward,  the 
inner  muscle  was  too  weak.  This  reasoning  nat- 
urally assumes  that  to  maintain  a  balance,  there 
is  a  constant  contention  in  the  various  eye  mus- 
cles, and  whenever  a  muscle  becomes  weaker  than 
its  fellow,  there  will  be  a  deviation  in  a  direction 
opposite  to  the  weak  one.  That  this  can  hardly 
be  true  is  evident  from  the  fact  that  the  internal 
rectus  is  known  to  have  generally  fully  five  or 
six  times  the  strength  of  its  opposite,  the  exter- 
nal rectus ;  and  if  it  were  a  relative  difference  in 
strength  of  the  muscles  that  caused  the  eyes  to 
deviate,  all  eyes  having  muscles  of  such  compar- 
ative strength  would  be  constantly  turned  in  to- 
ward each  other.  The  fact  is,  it  is  not  a  question 
as  to  the  relative  strength  of  the  muscles.  Nor- 
mal eyes  should,  under  absolute  relaxation  of  all 
9 


130  THE  EYE  IN  ITS 

the  muscles,  be  in  a  perfectly  parallel  plane  for 
an  infinite  distance ;  although  some  muscle  might 
be  weak,  an  eye  would  present  perfect  balance 
with  absolute  relaxation  of  the  muscle  opposite 
the  weak   one.     When  the  optic  axes  are  not 

PARALLEL,  THE  CONDITION  IS  DUE  TO  ONE  OF  TWO 
CAUSES EITHER  AN  ANATOMICALLY  SHORT  MUSCLE, 

OR  ONE  CONTRACTED  BY  SPASM.  This  rule  does 
not  hold  in  paralysis,  which  can  not  be 
determined  by  a  relative  position  of  the  optic 
axes  alone,  but  by  individual  movements  of  one 
eye.  Neither  are  the  tendencies  to  relative  devi- 
ation generally  due  to  paresis,  a  term  sometimes 
used  in  lieu  of  muscular  asthenopia. 

The  almost  universal  deviation  of  the  eyes  of 
the  dead,  the  blind,  the  new  born  babe ;  of  those 
who  have  been  rendered  unconscious  by  the  use 
of  anaesthetics,  alcohol  or  narcotic  poisons ;  and 
of  those  who  are  in  a  state  of  suspended  anima- 
tion from  other  causes,  such  as  fainting,  apo- 
plexy, or  coma,  is  due  to  a  suspension  of  inner- 
vation more  or  less  complete,  during  which  the 
eyes  fall  into  those  positions  in  which  the  ana- 
tomical length  of  the  muscles  would  naturally 
hold  them.  Deviations  under  the  above  condi- 
tions are  certainly  not  due  to  paresis  or  muscular 
weakness.  True,  we  do  have  weak  muscles,  but 
they  are  generally  on  the  side  of  the  eye  oppo- 
site to  that  in  which  the  theory  of  muscular  as- 


RELATION  TO  HEALTH.  131 

thenopia  would  have  them.  For  instance  ; 
when  the  deviation  of  an  eye  is  due  to  a  short 
external  muscle,  tending  to  draw  the  eye  out- 
ward, it  is  the  external  muscle  which  is  really  in- 
sufficient, asthenopic,  or  undeveloped,  for  never 
has  it  had  normal  action.  It  has  always  been 
drawn  upon  and  stretched  by  the  opposite  mus- 
cle, in  the  effort  of  the  latter  to  pull  the  eyes 
into  line.  In  such  cases,  gymnastic  exercise  of 
the  ocular  muscle  in  which  there  is  a  manifest 
deviation  will  sometimes  restore  the  physical  bal- 
ance, but  it  does  so  by  making  the  defect  latent 
again.  It  does  its  work  by  once  more  increasing 
the  already  excessive  innervation  to  a  hiding 
standard.  For  the  muscle  that  we  increase  in 
strength  by  gymnastic  exercise,  is  the  over-de- 
veloped one.  This  exercise  simply  stretches  the 
short  muscle  more,  and  increases  the  abnormal 
innervation  in  the  strong  one  ;  hence  the  results 
of  these  gymnastics  are  the  opposite  of  what  we 
should  seek  to  obtain.  Such  exercise  will  often 
restore  a  balance  of  the  optic  axes,  but  it  does  so 
at  the  expense  of  the  nerve-centers. 

In  that  class  of  cases  where  there  is  a  mani- 
fest deviation  of  the  optic  axes,  and  where  such 
deviation  is  due  to  a  spasm,  which  usually  turns 
the  eye  in  a  direction  opposite  the  short  muscle, 
gymnastic  exercise  will  bring  some  relief,  for  it 
represses  in  a  small  measure  the  abnormal  inner- 


132  THE  EYE  IN  ITS 

vation,  as  it  brings  the  eyes  back  into  line.  This 
relief  might  possibly  be  increased  by  crossing  the 
line  of  balance  and  forcing  the  eyes  in  the  oppo- 
site direction  to  a  considerable  extent  by  repres- 
sion. 

There  is  always  a  physical  comfort  in  seeing 
easily,  but  the  disturbances  arising  from  eye- 
strains are  not  always  local ;  they  do  not  always 
affect  the  vision. 

Whenever  the  shortness  of  a  muscle  begins 
to  manifest  itself,  we  may  infer  that  the  nerve- 
centers  have  wearied  of  holding  the  eyes  in 
place  and  begin  to  suspend  their  labor.  There 
is  an  effort  of  the  nerve-centers  to  rest  from  an 
over-taxed  condition,  and  we  should  always  aid 
them  as  much  as  possible  in  this  effort.  This  is 
done  by  placing  prisms  before  the  eye  in  the 
direction  opposite  to  that  prescribed  in  gymnas- 
tic exercise,  increasing  our  prism  in  this  direction 
as  long  as  fusion  will  take  place.  We  establish  a 
repressive  strain  in  the  opposite  direction ;  that 
is,  a  strain  in  which  there  is  an  effort  to  suspend 
nerve-impulse  which  has  become  excessive  and 
more  or  less  fixed  in  the  muscle  opposite  the 
short  one. 

By  exercising  this  repressive  strain  for  a  few 
weeks  or  even  months,  we  cannot  expect  to  sus- 
pend absolutely  and  entirely  an  abnormal  nerve- 
impulse  that  has  required  many  years  to  attain  its 


RELATION  TO  HEALTH.  133 

present  intensity.  We  should  reasonably  expect 
long  periods  of  time  to  be  necessary  to  repress 
these  brain  leaks  that  have  been  established  since 
birth. 

A  tendency  to  deviation  of  a  given  number  of 
degrees,  say  6,  will  give  rise  to  varying  amounts  of 
strain  in  different  individuals ;  for,  although  by 
reason  of  the  shortness  the  eyes  tend  to  deviate 
6  deg.  in  each  case,  the  innervation  that  brings 
the  eye  back  into  line  will  vary  in  accordance 
with  the  size,  strength  and  elasticity  of  the  short 
muscle.  A  thin,  weak  muscle  causing  the  axes 
of  the  eyes  to  deviate  6  deg.,  would  require  a 
certain  amount  of  motive-force  to  correct  the 
defect,  whereas,  a  broad,  tendonous,  inelastic 
muscle  that  turned  the  eye  6  deg.  would  require 
much  more  motive-force  to  bring  it  into  place. 

So,  THE  NUMBER  OF  DEGREES  OF  DEVIATION  IN  THE 
OPTIC  AXES  CAN  NEVER  DETERMINE  THE  AMOUNT  OF 
EYE-STRAIN. 

It  has  often  been  observed  that  considerable 
manifest  eye-strain  may  exist  without  materially 
inconveniencing  the  patient,  or  without  inducing 
any  noticeable  nervous  disturbance.  From  the 
fact  that  much  smaller  defects  have  apparently 
been  the  cause  of  excessive  nervous  disturbance, 
the  conclusion  drawn  by  some  has  been  that 
these  muscular  defects  are  not  responsible  for  the 
physical  conditions  co-existent  with  them.     This 


134  THE  EYE  IN  ITS 

is  erroneous  and  based  on  superficial  investigation. 
A  high  degree  of  manifest  defect,  say  20  deg., 
may  exist  as  in  the  case  No.  I  ;  but  there  is  a  great 
deal  of  the  time  during  which  the  eyes  are  at 
rest  in  manifest  troubles.  Many  times  during  the 
day,  and  always  during  sleep,  there  is  no  effort  of 
the  nerve-centers  to  parallelize  the  optic  axes. 
The  same  amount  of  anatomical  defect  that  we 
have  just  supposed  may  exist  in  a  case  where  it  is 
entirely  latent.  In  this  case  the  innervation  that 
sustains  parallelism  is  constant  and  fixed,  and 
the  strain  is  continuous.  It  is  a  constant  source 
of  nerve-center  drain  and  irritation.  Even  during 
the  hours  of  sleep  the  spasm  continues,  as  in  latent 
hyperopia.  Otherwise,  we  should  find,  on  waking 
a  person  from  sleep,  that  the  spasm  of  latent 
hyperopia  had  ceased  ;  but  such  is  not  the  case. 
The  same  character  of  tonic  spasm  may  exist  in 
any  of  the  long  muscles  as  well  as  in  the  ciliary. 
The  more  manifest  a  muscular  defect  is, 
the  less  will  be  the  strain  and  disturbance 
of  the  nerve-centers,  for  this  form  has 
periods  of  rest  ;  but  no  periods  of  rest  ever 
come,  even  during  sleep,  to  nerve-centers 
that  are  sustaining  absolutely  latent  eye- 
STRAIN. The  highest  state  of  nervous  dis- 
turbance EXISTS  WHERE  THE  DEFECTS  ARE 
ABSOLUTELY  LATENT,  OR  THEIR  MANIFESTATION 
REVERSED. 


RELATION  TO  HEALTH.  i35 

The  power  of  the  eyes  to  fuse  or  overcome 
prisms  held  in  various  directions  before  the  eyes, 
is  much  higher  at  the  near  point  than  at  a  dis- 
tance. At  twenty  feet  it  may  be  difficult  to  fuse 
2  deg.  or  3  deg.  of  prism,  whereas  6  deg.,  8  deg. 
or  10  deg.  may  be  fused  in  the  same  direction  at 
a  distance  of  ten  or  twelve  inches.  Cases  will 
vary  considerably,  and  no  general  rule  can  be 
laid  down,  but  fusion  power  is  always  much  higher 
at  the  near  point.  It  is  the  high  fusion  power  of 
the  near  point  that  I  often  find  very  useful  in 
treatment.  Fusion  power  is  proportionately  high- 
er under  a  bright  light,  or  one  of  high  candle 
power,  than  under  a  weaker  one.  A  plurality  of 
objects,  non-similarity  of  shape,  variety  of  color 
and  irregularity  of  arrangement,  emphasize  the 
fusion  stimulus  ;  on  the  other  hand,  any  imperfec- 
tion in  the  refractive  media  of  the  eye  would  dim 
or  lessen  the  acuity  of  vision  and  the  fusion 
power.  A  plain,  blank  surface  offers  no  stimulus 
for  fusion ;  a  single  point  offers  the  least. 

In  utilizing  fusion  power  to  establish  Repress- 
ive strain,  these  conditions  should  be  always  kept 
in  mind  ;  acuity  of  vision,  density  of  light,  num- 
ber of  objects,  and  distance. 

In  testing  with  prisms,  there  is  sometimes  an 
objection  to  using  a  light.  The  field  of  vision  is 
so  sensitive  in  some  eyes  that  the  faint,  doubly 
refracted  image  from  the  two  faces  of  the  prism 


136  THE  EYE  IN  ITS 

impresses  itself  on  the  retina  of  the  patient,  and 
this  is  mistaken  for  the  second  image  of  diplopia, 
which  it  is  not.  It  is  difficult,  for  this  reason,  to 
tell  whether  actual  fusion  has  taken  place.  Con- 
sequently, in  testing  with  prisms,  it  is  safer  to  use 
some  non-illuminated  object  to  look  at ;  but  a 
light  will  be  the  most  practical  where  the  vision 
is  foggy  after  an  operation,  or  from  other  causes. 

Again,  when  we  think  we  have  obtained  fusion, 
great  care  should  be  taken  to  make  ourselves  sure 
that  the  two  images  are  not  so  far  separated  from 
each  other  that  one  is  thrown  out  of  the  field  of 
vision,  or  so  far  into  it  as  to  cause  it  to  be  sup- 
pressed and  only  one  object  to  appear.  This  pre- 
caution should  always  be  taken. 

An  eye,  to  accommodate  itself  to  a  prism, 
always  turns  towards  its  apex.  For  this  reason, 
in  seeking  to  relieve  and  reverse  the  strain  of  a 
short  muscle  or  to  establish  a  repressive  strain 
with  prisms,  we  should  always  point  the  apex 
toward  the  short  muscle. 


RELATION  TO  HEALTH.  I37 


IX. 


ABNORMAL  innervation  of  the  ciliary  muscle 
is  very  common.  This  muscle,  surround- 
ing the  crystalline  lens,  exactly  as  the  metal  rim 
surrounds  a  spectacle,  possesses  the  power  to  con- 
tract itself  around  the  lens,  thus  increasing  its 
antero-posterior  convexities,  and  thereby  raising 
its  magnifying  power,  whenever  that  is  deficient. 
This  defect  in  the  lens  constitutes  hypermetro- 
pia — or  shorter,  hyperopia  —  a  condition  in  which 
the  rays  of  light  are  brought  to  a  focus  behind  the 
retina,  or  would  be  if  there  were  a  suspension  of 
innervation.  A  stimulus  for  perfect  vision,  or  a 
clearly  defined  impression  in  the  visual  centers  of 
the  brain,  is  awakened  by  the  imperfect  picture, 
and  the  impulse  is  sent  through  the  ciliary  nerves 
to  the  muscle,  thus  causing  it  to  contract,  so  that 
the  magnifying  power  of  this  little  glass  brings 
the  rays  of  light  to  a  perfect  focus,  producing  a 
clearly  defined  image  on  the  retina.  The  impact 
here  sends  impulses  to  the  visual  nerve-centers, 
giving  rise  to  the  feeling  of  perfect  sight,  which 
is  the  most  instructive  and  the  most  continuously 
enjoyable  of  all  our  senses.  If  the  crystalline 
lens  possessed  just  the  proper  curvatures  to  bring 


138  THE  EYE  IN  ITS 

about  perfect  refraction  at  an  infinite  distance 
without  any  effort  on  the  part  of  the  ciliary  mus- 
cle, it  would  still  require  an  effort  of  this  muscle 
to  increase  the  refractive  power  for  all  nearer  dis- 
tances than  twenty  feet.  This  is  called  accom- 
modation. Such  an  eye  would  be  natural  or 
emmetropic. 

When  imperfect  vision  is  due  to  a  deficiency 
of  refraction  in  the  crystalline  lens,  say  2  D,  or 
when  an  eve  whose  vision  is  practically  perfect 
will  accept  a  2  D  spherical  lens  without  impair- 
ment of  vision,  we  have  what  is  termed  manifest 
hypermetropia  to  the  extent  of  2  D.  We  might 
well  discriminate  between  these  two  forms  of 
manifest  hyperopia,  naming  the  first  Non-func- 
tional Manifest,  and  the  second  Functional  Mani- 
fest Hyperopia,  for  the  reason  that  in  the  first 
form,  the  function  of  vision  is  not  perfectly  per- 
formed, while  in  the  latter  it  is.  By  using  some 
drug  to  suspend  the  action  of  the  ciliary,  such  as 
atropine,  hyoscyamine,  and  their  congeners,  we 
may  perhaps  find  that  the  same  patient  cannot  see 
well  with  the  2  D  glasses,  but  now  requires  4  D, 
under  its  influence,  to  bring  about  the  best  possi- 
ble vision.  Without  the  drug,  we  had  2  D  of 
deficiency  of  refraction;  with  it,  4  D.  The  2  D 
is  called  manifest,  the  extra  2  D  developed  under 
the  drug  is  called  latent  hypermetropia.  It  has 
been  the   aim   of  the   profession  always  to  deter- 


RELATION  TO  HEALTH.  139 

mine  the  full  amount  of  latent  hyperopia.  The 
advice  given  in  all  text  books  has  been  to  put  on 
the  strongest  convex  glasses  with  which  the 
patient  could  make  out  twenty-twentieths  of 
vision,  also  the  weakest  concave  glasses,  thus 
recognizing  the  fact  that  it  is  always  advisable  to 
suspend  as  much  ciliary  strain  as  possible.  This 
idea  is  not  new,  it  is  a  time-honored  method  in  all 
text  books  of  the  past  as  well  as  the  present. 
The  fact  that  mydriatics  in  some  cases  are  variable 
in  their  action  on  the  same  patient  at  different 
times  and  under  various  conditions  of  health,  is 
known  to  every  oculist. 

Latent  hyperopia  may  exist  to  a  high  degree 
and  yet  be  undiscoverable  by  the  use  of  mydri- 
atics. In  many  cases  where  mydriatics  fail,  fog- 
ging will  reveal  a  high  state  of  hyperopia.  This 
relaxation  of  the  ciliary  by  repression  is  often 
temporarily  much  enhanced  by  the  administration 
of  lobelia,  wine  of  antimony,  ipecac  and  similar 
general  systemic  depressants  of  the  nervous  sys- 
tem. Conversely,  repression  is  retarded  by  stim- 
ulants. 

In  some  cases  of  hypermetropia,  hyoscyamine 
and  atropine  act,  at  different  times,  quite  uniformly 
in  discovering  various  amounts  of  deficient  refrac- 
tion ;  in  others,  their  action  is  uncertain  and  vari- 
able to  a  considerable  extent ;  while  in  some 
cases,  these  drugs  have  failed  to  give  the  slight- 


140  THE  EYE  IN  ITS 

est  evidence  of  hypermetropia,  which  has  been 
revealed  afterwards  by  the  process  of  fogging. 

As  in  case  No.  2,  page  81,  a  two  grain  solution 
of  atropine  was  dropped  into  the  eyes  twice  a  day 
for  one  week,  as  a  test  for  hyperopia,  but  no 
hyperopia  was  developed.  The  solution  was 
increased  in  strength  to  four  grains  to  the  ounce 
and  continued  for  three  days.  The  constitutional 
effect  of  the  drug  was  so  prominent,  that  I  was 
obliged  to  discontinue  it  at  this  time.  On  exam- 
ining the  eyes,  I  again  found  no  indication  of 
hypermetropia.  Vision  without  the  glasses  was 
twenty-twentieths  or  normal.  I  prescribed  a  +1 
D  glass  for  outdoor  use,  which  gave  twenty-fif- 
tieths of  vision  at  twenty  feet.  For  house,  read- 
ing, writing,  and  all  close  purposes,  I  prescribed  a 
-j-4  D,  which  was  i  D  more  than  an  absolute  sus- 
pension of  the  accommodation  at  thirteen  inches. 
This  rendered  the  patient  artificially  myopic.  At 
the  expiration  of  three  months,  through  the  +1 
D  glasses  at  twenty  feet,  vision  was  twenty-twen- 
tieths, and  though  the  glasses  were  removed, 
vision  continued  normal,  but  when  they  were 
returned  to  the  eyes,  the  vision  through  the 
glasses  was  reduced  to  twenty-thirtieths,  and 
required  about  half  an  hour  to  regain  its  normal 
condition.  I  now  increased  the  power  of  both 
pairs  of  glasses  .75  of  a  dioptre,  which  again  gave 
twenty-fiftieths  of  vision  for  objects  at  a  distance, 


RELATION  TO  HEALTH.  141 

and  for  objects  at  twelve  inches  the  same  amount 
of  artificial  myopia  that  the  first  pair  of  reading 
glasses  gave.  At  the  expiration  of  six  months 
more,  vision  under  the  1.75  D,  at  twenty  feet,  was 
normal.  On  removing  these  glasses,  some  five  min- 
utes were  now  required  for  normal  vision  to  take 
place,  indicating  that  the  reduction  of  ciliary  in- 
nervation was  becoming  somewhat  fixed.  The 
glasses  were  continued  as  well  as  the  above 
modus  operandi  for  a  period  of  three  years,  since 
which  time  the  patient  has  been  wearing  -|-  2.75 
for  all  general  purposes.  With  these  glasses 
vision  is  twenty-twentieths  at  all  distances,  but 
for  the  purpose  of  resting  the  accommodation,  a 
+  5  D  is  frequently  resorted  to  for  long  and  con- 
tinued close  work. 

If  serious  nervous  disturbances  have  been  held 
in  check  by  the  above  process,  it  is  not  advisable, 
after  any  given  length  of  time,  to  prescribe  glasses 
which  will  give  fully  twenty-twentieths  of  vision, 
but  to  increase  their  power  .25  or  .50  of  a  dioptre 
so  as  to  produce  about  twenty-thirtieths,  when 
practicable  with  the  patient.  Fogging  fulfills  a 
double  purpose ;  first,  the  tendency  to  repress 
ciliary  innervation  is  continued ;  next,  the  visual 
centers  are  relieved  from  taking  impressions  of 
numerous  definable  points,  and  great  rest  is  often 
so  attained. 

Fogging,  for  the  discovery  of  high  degrees  of 


142  THE  EYE  IX  ITS 

latent  hyperopia  where  mydriatics  fail,  I  believe 
to  be  entirely  new.  Naturally  the  criticism  might 
be  made  that  it  would  break  down  the  accommo- 
dation. It  certainly  does  break  down  a  laborious 
accommodation  that  always  exists  where  there  is 
a  high  degree  of  latent  hyperopia,  which  is  mak- 
ing a  constant  and  extravagant  call  on  the  nerve- 
centers.  It  breaks  down  a  state  of  perfect 
accommodation  that  under  highly  abnormal  con- 
ditions not  only  exists,  but  often  proves  very 
injurious  to  health.  This  is  what  it  has  always 
been  our  purpose  to  do  with  mydriatics.  A  new 
and  more  perfect  accommodation  is  soon  estab- 
lished, which  is  more  favorable  to  conditions  of 
health. 

In  such  localities  as  England,  the  northwest 
coast  of  North  America,  and  similar  sections  of 
country  where  during  a  great  part  of  the  time  the 
atmosphere  is  humid  and  foggy,  nervous  ailments 
are  not  so  common,  because  the  sharpness  of 
vision  is  much  diminished  bv  the  haziness  of  the 
atmosphere,  and  the  sight  centers  of  the  brain  are 
not  exercised  to  the  same  extent  as  in  a  clear, 
bright  view,  where  the  most  minute  objects  are 
distinctly  seen,  and  constantly  taxing  the  nerve- 
centers  with  their  impressions.  For  vision  is  an 
active  function  even  when  it  is  the  easiest  pos- 
sible. It  will  often  be  found  that  besides 
repression,  one   of    the    results    of    fogging  with 


RELATION  TO  HEALTH.  T43 

glasses  is  a  state  of  rest  and  quiet,  and  sometimes 
sleep. 

A  question  naturally  rises  here — Are  the  con- 
ditions which  we  are  seeking  to  alleviate  by  re- 
pression of  the  ciliary,  as  well  as  by  laborious 
attempts  to  repress  the  long  muscles,  of  sufficient 
gravity  to  warrant  the  inconvenience  to  the 
patient  ?  The  reply  must  depend  on  the  state  of 
the  patient's  health. 

Latent  hyperopia  is  a  condition  of  more  or  less 
perfect  vision  that  is  sustained  by  a  constant  and 
firmly  fixed  excess  of  innervation  to  the  ciliary 
muscle.  We  will,  in  this  immediate  connection, 
consider  myopia  or  near-sightedness,  for  I  believe 
it  properly  belongs  to  the  same  line  of  thought. 
It  is  often  the  case  that  where  the  superior  rectus 
is  too  short,  the  inferior  rectus,  instead  of  draw- 
ing the  eye  down  to  a  balance  with  its  fellow, 
draws  it  beyond,  through  an  excess  of  nerve- 
force  ;  and  myopia  is  a  condition  depending  at 
first  on  a  similar  spasm.  In  my  opinion  this 
defect  takes  its  origin  nearly,  if  not  always,  as 
hypermetropia,  but  the  nerve-impulse  that  in- 
creases the  convexity  of  the  lens  to  correct  the 
hypermetropia,  exceeds  that  office  ;  it  passes  the 
point  where  the  refraction  would  produce  clear 
and  distinct  vision,  and  near-sightedness  is  the 
result.  It  becomes  an  excessive  impulse,  fixed  or 
progressive,  arising  from  deranged  nerve-centers. 


144  THE  EYE  IN  ITS 

Thus  myopia  is  the  result  of  a  nervous  disturb- 
ance which  causes  an  associated  disarrangement 
in  the  impulses  of  assimilation  in  various  parts  of 
the  eye,  especially  in  the  sclerotic  coat.  This  dis- 
turbance in  the  nutrition  of  the  sclerotic  and 
other  parts,  tending  to  soften  them  and  lessen 
their  mechanical  support,  together  with  the  press- 
ure of  the  rectus  muscles,  probably  brings  about 
that  elongation  of  the  eye  that  we  find  in  axial 
myopia.  The  further  these  abnormal  conditions 
proceed,  the  greater  the  source  of  irritation  to  the 
nerve-centers.  In  hereditary  myopia,  as  in  other 
hereditary  diseases,  there  is  undoubtedly  trans- 
mitted a  condition  of  the  nerve-centers  which 
tends  to  produce  the  difficulty.  All  evidence 
bears  out  the  fact  that  myopes  generally  are 
people  of  a  higher  civilization,  who  exercise  their 
eyes  at  the  near  point,  and  thus  establish  an 
abnormal  impulse  in  the  ciliary  centers  during 
such  use  of  the  eyes.  The  stimulus  has  been  so 
constant  for  a  long  period  that  the  impulse  to  the 
ciliary  is  unable  to  suspend  itself  and  bring  about 
distant  vision  again.  The  motive-impulse  keeps 
coming.  The  ciliary  will  not  relax  from  its  con- 
tracted condition,  the  refraction  remains  high, 
and  the  patient  near-sighted.  This  exercise  of 
the  ciliary  centers  through  years,  in  one  or  more 
generations,  causes  a  differentiation  tending  to 
produce  an  excessive  ciliary  impulse. 


RELATION  TO  HEALTH.  145 

In  hyperopia,  the  nerve-impulse  that  causes 
the  ciliary  muscle  to  contract  and  increase 
the  refraction  of  the  crystalline  lens,  is 
abnormal,  yet  it  performs  a  normal  function; 
whereas  in  myopia  the  function  and  the  im- 
PULSE ARE  BOTH  ABNORMAL.  The  circular  fibres  of 
the  ciliary  are  hypertrophied  in  hypermetropia ; 
they  are  hypertrophied  also  in  myopia  previous  to 
its  becoming  axial,  but  atrophied  after  it  becomes 
axial,  that  is,  when  the  eye  begins  to  elongate ; 
for  this  elongation  necessitates  the  suspension  of 
ciliary  contraction  to  maintain  distinct  vision  even 
at  the  near  point.  As  the  eye  elongates,  the 
repression  that  goes  on  in  the  ciliary  is  of  the 
highest  type,  being  exercised  at  the  near  point, 
thus  suspending  the  action  of  the  circular  fibres  of 
the  ciliary  muscle,  and  their  atrophy  naturally 
follows. 

This  natural  forced  repression,  which  increases 
with  the  progress  of  axial  myopia,  suspends  the 
ciliary  impulse  more  or  less  completely,  and  in 
such  a  case  we  should  not  expect  those  nervous  dis- 
turbances that  depend  on  ciliary  strain  ;  but  in  a 
a  mixed  case,  where  concave  glasses  are  worn  for 
all  distances,  and  the  ciliary  is  taxed  with  the 
accommodative  effort  of  the  near  point,  I  have 
sometimes  found  that  the  removal  of  the  concave 
glasses  for  reading  suspended  some  accompany- 
ing nervous  condition. 
10 


146  THE  EYE  IN  ITS 

The  following  are  some  very  interesting  exper- 
iments in  myopia  which  can  be  verified  by  any 
operator,  and  which  prove  that  refractive  myopia 
depends  on  ciliary  spasm,  and  that,  even  in  axial 
myopia,  considerable  repression  can  sometimes  be 
made  at  the  near  point.  In  either  class  of  cases, 
repression  must  be  made  at  the  near  point.  In 
various  lengths  of  time,  we  shall  be  able  to  reduce 
the  myopia  one  or  two  dioptres,  sometimes  more. 
In  most  cases  satisfactory  results  will  require  con- 
siderable time  and  patience ;  but  a  few  experi- 
ments after  the  following  example  will  suffice  to 
show  that  in  some  very  advanced  stages  of 
myopia,  it  is  possible  to  suppress,  or  at  least 
check,  its  onward  course  by  repression  at  the 
near  point.  This  fact  renders  the  fitting  of  minus 
glasses  to  myopic  eyes  an  open  question. 

M.  S.,  age  thirty-five  ;  has  been  wearing  minus 
glasses  since  the  age  of  twelve  ;  obliged  at  various 
times  to  increase  the  power.  When  I  saw  the 
patient,  she  was  wearing  — 5  D  for  all  purposes. 
Vision  with  each  eve,  at  twenty  feet,  was  twenty- 
twentieths,  or  normal.  The  addition  of  half  a 
dioptre  increased  the  acuity  of  vision  to  twenty- 
fifteenths,  or  above  normal.  A  reduction  of  the 
power  of  the  — 5  D  glass  to  — 4.75  reduced  the 
distant  vision  to  twenty  one-hundredths.  This 
glass  was  worn  one  week,  and  the  vision,  instead 
of  having  been  improved,  was  reduced  to  twenty 


RELATION  TO  HEALTH.  HT 

two-hundredths.     A  return  to  the  — 5  D  restored 
the  vision  to  twenty-twentieths.     Vision  was  also 
normal  at  the  near  point.    On  removing  the  glasses 
she  was  able  in  a  few  minutes  to  read  ordinary 
type  at  eight  inches,  but  no  farther.      Repeated 
tests  for  half  an  hour  resulted  similarly.     A  +3 
D  was  now  put  on  the  patient,  necessitating  the 
holding  of  the  type  somewhat  nearer  to  the  eyes. 
After  twenty-five   minutes,  she  was  able  to  read 
with    +3    D   at   eight   inches.     After   continuing 
them  for  an  hour,  and  then  removing  them,  the 
patient  was  able  to  read  the  same  type  at  twelve 
inches  ;  but  this  condition  was  of  short  duration, 
necessitating  the  gradual  approach  of  the  letters 
until,  within  five  minutes,  the  type  was  again  eight 
inches  distant.     Under  the  high  fusion  power  of 
the   near   point,   the   ciliary   spasm    had    become 
repressed  or  partially  suspended  while  the  +3   D 
glasses  were  before  the  eyes,  and  it  did  not  return 
immediately  on   removal   of  the   glasses ;  conse- 
quently the  same  print  could  be  seen  at  twelve 
inches,  but  within  five  minutes  the  old  innervation 
of  the  ciliary  had  re-established  itself,  necessitat- 
ing the  holding  of  the  print  to  within  eight  inches 
again.     At  the  far  point,   in  this  test,  the  fusion 
power  was  not  sufficiently   high   to  permit  of  a 
reduction  of  .25  D  in  the  — 5  D  glasses.     We  see 
that  it  required  fully  twenty-twentieths  of  vision 
to  bring  about  fusion  power  enough  to  prevent  the 


148  THE  EYE  IN  ITS 

ciliary  spasm  from  increasing,  for  when  it  was 
reduced  .25  D  the  myopia  increased  rapidly  in  one 
week. 

The  patient  was  a  constant  reader,  which  it 
will  be  seen  was  a  great  aid  to  the  results  of  my 
following  effort. 

I  prescribed  a  +3  D  glass  for  all  reading. 
This  continued  for  thirty  days  during  which  time 
no  concave  glasses  were  worn  for  out-door  or  dis- 
tant purposes.  When  I  again  tested  the  vision  for 
the  far  point,  the  patient  could  with  — 4.25  D, 
bring  out  twenty-twentieths  of  vision,  being  a 
reduction  of  .75  D  in  one  month.  The  same  trial 
was  continued  for  another  month  with  a  still  fur- 
ther reduction  of  .25  D,  making  in  all  i  D  in  two 
months.  During  this  time,  some  favorable  changes 
took  place  in  the  condition  of  the  nervous  system. 
Just  how  far  we  could  have  succeeded  in  time  in 
reducing  this  case  of  myopia,  we  do  not  know. 
Impatience  and  the  inconvenience  necessary  to  this 
procedure,  influenced  the  patient  at  this  point  to 
abandon  the  effort.  Neither  is  it  possible  to  state 
just  how  much  of  this  myopia  was  axial,  which 
amount,  of  course,  would  not  have  been  influenced 
by  the  repression  process. 

Age  forty-three ;  myopia ;  had  been  wearing 
over  the  right  eye  — 1.25  D,  left  eye  — i  D,  with 
little  or  no  change  for  the  space  of  two  years ; 
eyes  in  use  more  or  less  at  the  near  point.     I 


RELATION  TO  HEALTH.  149 

recommended  the  removal  of  the  concave  glasses 
for  distant  vision  and  prescribed  +3.50  D  for 
reading,  writing  and  other  office  work.  After 
reading  in  these  glasses  for  several  days,  the 
patient  was  able  to  read  print  twelve  inches  from 
the  eyes.  This  patient  was  of  more  than  ordinary 
intelligence  and  understood  the  aim  of  the  effort. 
In  six  months  I  changed  the  glasses  for  reading 
and  writing  to  a  -|-4  D  without  seeing  the  patient. 
After  using  the  -|-4  D  glasses  for  several  months 
he  again  came  under  my  care  for  an  examination, 
when  the  left  eye  gave  twenty-twentieths  of  vision, 
while  the  right  eye  was  very  nearly  the  same,  but 
the  acuity  was  just  perceptibly  less.  During  this 
time  the  general  health  had  improved  somewhat, 
including  considerable  gain  in  the  nervous  condi- 
tion. Similar  results  have  been  attained  in  thir- 
ty-four like  cases;  but  the  process  is  very  tedious 
for  the  patients,  and  unless  their  understanding  is 
clear  on  the  subject,  it  is  almost  impossible  to 
induce  them  to  undergo  the  trial. 

The  foregoing  in  connection  with  limited  tests 
of  more  than  two  hundred  similar  cases  suggests 
an  answer  to  that  most  important  question,  'What 
shall  we  do  to  prevent  myopia  in  school  children 
and  students  ?' 

In  a  nomad,  who  is  reared  out  of  doors,  who 
follows  such  pursuits  that  his  vision  is  mostly  used 
at  twenty  feet  and  greater  distances,  the  nerve- 


150  THE  EYE  IN  ITS 

impulses  to  the  ciliary  muscle  become  established 
so  that  the  easiest  vision  is  for  the  far  point,  and 
in  many  years  of  such  use,  these  impulses  become 
more  or  less  fixed ;  while  the  child  of  a  higher 
civilization  spends  its  life  within  doors,  amuses 
itself  with  toys,  picture  books,  kindergarten 
amusements  and  learning  to  read.  We  will  assume 
that  such  a  child  generally  holds  its  book  or  toy 
ten  inches  from  the  eyes,  in  which  case  the  crys- 
talline lens  requires  a  much  greater  convexity,  or 
higher  state  of  refraction  to  bring  about  perfect 
vision ;  and  this  is  brought  about  by  an  increase 
in  the  ciliary  nerve-impulse  which  contracts  the 
ciliary  muscle.  Through  long  continued  use,  this 
excessive  impulse  becomes  comparatively  fixed, 
and  in  some  instances  refuses  to  suspend  itself 
sufficiently  to  bring  about  distant  vision  again, 
and  so  myopia  has  set  in.  The  regular  work  of 
the  student  and  those  other  pursuits  which  re- 
quire the  use  of  the  eye  at  the  near  point,  tend  to 
perpetuate  this  disease  and  make  it  progressive. 
Again,  the  important  question,  '  How  are  the 
advantages  of  a  high  civilization  to  be  attained 
without  the  foregoing  disadvantages?'  If  the 
eyes  are  to  be  used  at  a  distance  of  ten  inches,  aid 
them  artificially  by  a  ten  inch  magnifying  glass ; 
then  the  nerve-impulses  to  the  ciliary  muscle 
will  be  no  more  than  if  the  patient  were  leading 
an  outdoor  life  and  viewing  objects  at  twenty  feet 


RELATION  TO  HEALTH.  151 

or  more.  The  nerve-centers  are  not  called  upon 
for  so  excessive  an  impulse,  and  they  become 
habituated  to  sending  the  same  amount  of  nerve- 
force  as  if  an  outdoor  life  were  led.  In  conjunc- 
tion with  this  artificial  aid  to  the  ciliary  centers, 
it  may  be  found  advantageous  to  suspend,  in 
a  measure,  the  excessive  nerve-impulses  to  the 
interni,  by  the  use  of  prisms,  base  in.  Under 
these  artificial  conditions,  the  eyes  may  be  used 
in  the  attainment  of  all  the  advantages  of  the 
highest  civilization  while  the  nerve-centers  are  no 
more  taxed  than  if  out  of  door  pursuits  were  being 
followed.  If  the  little  student  at  school  or  any 
other  person  using  the  eyes  at  the  near  point, 
were  to  be  supplied  with  such  glasses  during 
the  hours  of  study,  on  leaving  the  school  room 
they  could  be  taken  off  and  the  natural  use 
of  the  eye  at  all  other  times  would  be  quite 
sufficient  to  cultivate  and  establish  the  habit  of 
accommodation.  At  least  the  danger  of  disturb- 
ing the  accommodation  would  be  much  less  than 
the  dangers  resulting  to  the  eyes  and  nerve- 
centers  without  such  aid. 

I  simply  suggest  the  above  as  a  possible 
answer  to  one  of  the  most  important  questions  of 
the  day. 

Astigmatism,  or  that  condition  in  which  the 
refraction  of  the  eye  is  different  in  various  meri- 
dians.    Illustration  :     In  the  horizontal  meridian, 


152  THE  EYE  IN  ITS 

-\-2  D  is  required  to  correct  the  irregularity  of 
refraction,  while  in  the  opposite  or  vertical  meri- 
dian, +4  D  is  needed.  Astigmatism  is  generally 
due  to  an  irregularity  of  the  spherical  contour  of 
the  cornea,  its  curvatures  being  different  in  vari- 
ous meridians,  requiring  a  stronger  lens  to  correct 
it  in  one  direction  than  the  other.  Corneal  astig- 
matism is  almost  always  due  to  the  fact  that  some 
of  the  muscles  of  the  eye  ball  are  exerting  greater 
tension  in  one  meridian  than  another.  For  in- 
stance :  A  shortness  of  the  internal  or  external 
muscle,  inducing  considerably  more  stress  later- 
ally than  the  superior  and  inferior  muscles  exert 
in  a  vertical  direction,  would  cause  the  cornea  to 
be  distorted  horizontally,  and  vice  versa.  The 
many  possible  varying  conditions  of  tension  in  the 
muscles  produce  corresponding  deformities  in  the 
contour  of  the  cornea,  resulting  in  various  forms 
of  astigmatism.  Wherever  corneal  astigmatism 
exists,  it  is  fairly  safe  to  conclude  that  it  is  due  to 
some  muscular  strain.  After  correction  of  mus- 
cular defects,  it  is  quite  common  for  large  amounts 
of  astigmatism  to  disappear,  and  leave  the  eye  in 
perfect,  spherical  shape.  In  the  foregoing 
remarks,  I  refer  to  corneal  astigmatism  only. 


RELATION  TO  HEALTH.  153 


X. 


THE  short  or  stretched  muscles  never  assume 
much  if  any  normal  action.  They  are 
always  being  stretched  and  relaxed  again,  conse- 
quently they  are  thin,  attenuated,  and  undevel- 
oped. 

Under  this  irregular  condition,  the  most  deli- 
cate correlated  action  exists  in  the  various  move- 
ments of  the  eye,  just  as  if  perfect  anatomical 
conditions  existed.  The  nice  relation  existing 
between  the  accommodative  effort  of  the  ciliary 
muscles  and  the  relative  convergence  of  the  optic 
axes  to  fix  them  for  various  distances,  is  main- 
tained to  a  mathematical  nicety.  In  exophoria, 
where  convergence  is  performed  by  a  contraction 
of  the  internal  recti,  and  divergence  is  performed 
by  a  relaxation  of  the  same,  it  is  the  amount  of 
innervation  sent  to  the  interni  that  in  part  estab- 
lishes our  judgment  of  distance.  In  a  marked 
case  of  esophoria  or  short  internal  muscles,  where 
the  act  of  divergence  from  the  near  point  to  par- 
allelism is  performed  by  an  excessive  contraction 
of  the  external  muscles,  and  convergence  to  the 
near  point  by  a  relaxation  of  the  same,  it  is  the 
variation  of  innervation  to  the  external  muscles 


154  THE  EYE  IN  ITS 

combined  with  the  effort  of  the  ciliary  muscles 
that  determines  our  judgment  of  distance. 

In  esophoria,  or  convergence  due  to  short 
internal  muscles,  where  their  length  is  such  that 
the  optic  axes  would  be  converged  for  a  distance 
of  ten  or  twelve  inches  during  the  absence  of 
innervation,  it  is  through  the  agency  of  nerve- 
impulse  to  the  external  muscles  that  the  optic 
axes  are  drawn  into  parallelism  for  distant  vision; 
and  when  the  near  point  is  again  sought  and  the 
ciliary  accommodation  increases  the  refraction, 
it  is  not  as  has  been  generally  assumed,  an  asso- 
ciated contraction  of  the  internal  muscles  that 
converges  the  eyes;  it  is  a  negative  action,  a  sus- 
pension of  innervation  to  the  external  muscles. 

The  nice  and  delicate  correlated  action  of  the 
various  parts  of  the  eye  has  been  assumed  by 
some  to  be  a  delicacy  of  mechanical  balance  of 
the  various  muscles,  but  this  is  seldom  if  ever 
true.  In  nearly  all  cases,  the  balance  is  main- 
tained by  innervation  which  is  the  outgrowth  of  a 
stimulus  in  the  nerve-centers  for  perfect  vision. 
In  such  cases,  the  abnormal  nerve-impulses  have 
continued  so  long  in  the  performance  of  their 
various  duties,  that  they  have  become  fixed 
impulses  and  they  are  virtually  interlocked  with 
each  other. 

There  are  numerous  cases  of  defective  eye- 
balance   where  short  and  abnormally  innervated 


RELATION  TO  HEALTH.  155 

muscles  exist  in  one  or  more  situations  which 
seem  to  be  firmly  and  most  fixedly  locked 
throughout,  one  with  the  other.  To  make  myself 
thoroughly  understood,  I  will  assume  to  know 
just  how  much  tendency  to  deviation  there  is  in  a 
given  case  in  the  absence  of  innervation.  The 
left  superior  is  short  enough  to  cause  the  eye  to 
deviate  6  deg.  upward,  and  the  two  externals  20  deg. 
outward,  while  the  ciliary  is  making  up  for  3  diop- 
tres of  latent  hyperopia.  All  of  these  conditions 
are  latent.  Excessive  innervation  of  the  inferior 
muscle  pulls  the  eye  down  against  the  short 
superior;  abnormal  innervation  to  the  interni 
draws  the  eyes  to  a  balance  against  the  short 
externals,  and  the  ciliary  at  the  same  time  is  mak- 
ing up  the  3  dioptres  of  deficient  refraction  in  the 
crystalline  lens,  until  the  function  of  perfect  vis- 
ion is  the  result,  and  all  defects  are  hidden. 
It  sometimes  is  a  very  tedious  and  puzzling 
problem  to  upset  or  unlock  this  correlated  con- 
dition of  abnormal  impulses,  and  reveal  the 
defects.  If  the  abnormal  innervation  of  one  of 
these  muscles  can  be  interfered  with  and  broken, 
there  will  be  a  general  unfolding  of  all  the 
defects.  It  is  sometimes  difficult  to  know  where 
to  begin.  A  few  hours'  or  days'  fogging  may 
relax  the  ciliary  spasm,  and,  after  it  has  yielded, 
defects  in  other  muscles  will  begin  to  manifest 
themselves;  then  development  in  that  particular 


156  THE  EYE  IN  ITS 

direction  may  be  taken  up  and  followed  until 
the  condition  of  the  eye  is  revealed  with  abso- 
lute certainty,  by  careful  adherence  to  symptom 
tests. 

Sometimes  the  ciliary  spasm  does  not  readily 
yield  to  fogging,  in  which  case  it  may  be  easier 
to  discover  some  defect  in  one  of  the  long 
muscles,    for   illustration,    the   left   superior.      In 

this  case  an  examination  with  dots 

or    lights    might    show    the    two 

^~~""""""""      objects  to  be  perfectly  horizontal, 

■      or  so  nearly  so  that    the  patient 

^.^__^_      could  not  discern  that  one   light 

was  higher  than    the   other.      By 

<JL>  using  a  chart  with  a  star  or  dot  in 

the  middle,  and  lines  drawn  hori- 
'  zontally  across  the  chart  both 
^_^— ^  above  and  below  the  dot,  equi- 
^_^_____^___^  distant  from  each  other  so  as  to 
represent  for  each  space  i  deg.  at 

the  distance  of  examination.  By 
the  use  of  a  5  deg.  prism,  base  down,  first  before 
one  eye  and  then  before  the  other,  there  will  in 
each  position  appear  to  be  two  stars,  with  possi- 
bly four  lines  between  the  stars  in  each  posi- 
tion. We  then  reduce  the  prism  to  4  deg.  and 
find  the  same  result;  then  to  3  deg.,  where  we 
may  possibly  find  that  a  difference  will  manifest 
itself.       That    is,    with     the    prism,   base   down, 


RELATION  TO  HEALTH.  157 

before  the  right  eye  there  will  perhaps  be  two 
stars,  while  before  the  left  eye  there  will  appear 
only  one.  Or,  if  there  be  no  difference  with 
the  3  deg.  prism,  we  resort  to  a  2  deg.  prism, 
with  which,  if  there  is  any  difference,  we  shall 
discover  it  by  there  being  perhaps  two  stars 
before  the  left  eye  with  no  lines  between,  while 
before  the  right  there  may  be  two  stars  with  one 
line  between;  or  we  may  have  to  use  a  i  deg. 
prism  before  we  find  the  difference,  which  will 
possibly  be  fusion  before  the  left  eye,  while  there 
are  two  stars  with  the  same  prism,  base  down, 
before  the  right.  Perhaps  even  here  the  only 
difference  that  can  be  noted  will  be  that  the  vision 
is  much  more  perfect  with  the  i  deg.  prism,  base 
down,  before  the  left  eye  and  more  indistinct  in  the 
same  position  over  the  right.  We  can  then  place 
in  our  trial  frame  a  i  deg.  prism,  base  down, 
before  the  left  eye.  In  ten  minutes,  more  or  less, 
the  same  eye  will  be  able  to  accommodate  itself 
for  2  deg.,  and  a  little  later  for  3  deg.,  4  deg.,  and  5 
deg.,  and  so  on  up  sometimes  to  8  deg.  or  10  deg. 
within  an  hour  or  two,  while  at  the  beginning  the 
eyes  could  not  accommodate  themselves  to  i  deg. 
or  2  deg.  of  prism  in  the  same  position.  The  sur- 
mounting of  this  difficulty  will  sometimes  cause  a 
tonic  unyielding  spasm  in  the  ciliary  to  begin  to 
manifest  itself,  where  it  would  not  readily  do  so 
as   represented  above  by  fogging.      It  may  also 


158  THE  EYE  IN  ITS 

unfold  some  defect  in  the  internal  or  external 
muscles. 

We  can  with  advantage  oftentimes  carry  on 
repression  in  three  directions  at  the  same  time. 
For  instance,  as  in  case  11,  page  105,  ciliary 
repression  with  -I-3D  spherical,  left  inferior  rectus 
14  deg.,  base  down,  with  18  deg.,  base  in.  The 
suspension  of  repression  in  any  one  of  these  three 
directions  in  this  case  materially  aggravated  the 
symptoms.  Inasmuch  as  fogging  diminishes  the 
fusion  stimulus  for  the  distance,  we  are  often 
obliged  to  sacrifice  some  repression  in  this  direc- 
tion for  the  purpose  of  increasing  it  in  another, 
or  to  increase  repression  in  this  direction  by 
sacrificing  it  in  another.  Extraordinary  care, 
patience  and  judgment  are  necessary  at  all  times 
in  the  process  of  repression.  Considerable 
variations  in  the  condition  of  the  nerve-centers 
ranging  from  depressed  to  more  exalted  states, 
often  oblige  us  to  retreat  by  reducing  our  prism 
in  one  or  more  directions  for  the  purpose  of 
remaining  within  the  range  of  fusion.  In  some 
cases  this  will  occur  repeatedly,  and  at  times  may 
have  a  tendency  to  confuse  us.  Such  circum- 
stances should  make  us  doubly  careful,  but  should 
not  deter  us  from  attacking  the  same  position 
again  as  soon  as  practicable. 

The  following  is  a  continuation  of  the  test  of 
the  vertical  muscles  where  they  will  accommodate 


RELATION  TO  HEALTH.  159 

for  larger  amounts  of  prism.  It  has  been  a  com- 
mon practice  to  use  a  3  deg.  prism,  base  down, 
first  before  one  eye  and  then  before  the  other.  If 
fusion  takes  place  in  both  these  positions,  the 
inference  has  been  that  there  is  nothing  defi- 
cient in  a  superior  or  inferior  muscle ;  but  this 
conclusion  is  erroneous,  for  serious  defects  may 
exist  without  the  above  test  giving  the  slightest 
indication  of  it. 

When  fusion  takes  place  with  a  3  deg.  prism, 
base  down,  before  either  eye,  we  should  next  re- 
sort to  a  4  deg.  prism.  If  fusion  takes  place  with 
this,  we  should  then  use  a  5  deg.,  and  continue  to 
increase  the  power  of  the  prism  until  the  highest 
degree  is  reached  where  fusion  will  take  place. 
It  may  be  six,  seven  or  even  more  degrees,  and  if 
fusion  takes  place  before  one  eye  equally  with 
the  other,  there  is  apparently  no  difference  as 
recorded  by  this  test.  If,  on  arriving  for  instance, 
at  a  7  deg.  prism  we  find  it  will  fuse  before  the 
left  and  constantly  refuse  to  do  so  before  the 
right  eye,  we  assume  to  have  discovered  a  short- 
ness in  the  muscle  toward  the  apex  of  the  prism 
where  the  highest  fusion  takes  place,  and  the  cor- 
rectness of  our  inference  should  always  be  verified 
by  symptom  tests. 

Now,  before  the  eye  that  fuses  for  the  highest 
degree  of  prism,  we  continue  to  add  more,  until 
we  have  reached  the  highest  number  of  degrees 


i6o  THE  EYE  IN  ITS 

under  which  fusion  will  take  place,  which  may 
possibly  be  ten  or  more  degrees  of  prism  more 
than  the  opposite  eye  would  fuse  for.  If  any 
such  result  is  obtained,  we  should  take  off  all 
prism  for  a  time  and  repeatedly  endeavor,  by 
careful  coaxing,  to  see  if  the  eye  that  accepted 
the  less  prism  can  in  any  way  be  drawn  to  take 
on  an  equal  amount  with  the  other  eye.  If  it 
persistently  refuses  to  do  so,  we  should  then 
apply  to  the  other  eye  all  that  it  will  accept. 
During  this  time  we  should  constantly  observe 
what  changes,  if  any,  take  place  in  some  promi- 
nent symptom  or  symptoms  of  the  patient's  dis- 
order. If  there  be  a  marked  change  for  the  better 
in  the  action  of  the  heart,  or  in  some  other  con- 
dition, it  is  evident  that  we  are  turning  the  eye  in 
the  direction  of  the  short  muscle  and  repressing 
the  abnormal  innervation  in  the  opposite ;  but  if 
the  disturbed  conditions  are  emphasized  as  we 
proceed,  it  is  very  evident  that  the  eye  is  being 
turned  in  a  wrong  direction  and  that  we  are  being 
led  on  by  a  short  muscle,  the  shortness  of  which 
is  due  to  spasm  and  not  an  anatomical  defect.  In 
this  case  we  are  increasing  the  abnormal  innerva- 
tion and  the  irritation  of  the  nerve-centers. 

During  our  first  efforts  at  repression  we  may 
not  at  once  effect  sufficient  change  in  the  dis- 
turbed conditions  of  the  patient  to  assure  us  that 
our  repression  is  correct,  in  which  case  we  should 


RELATION  TO  HEALTH.  i6i 

turn  our  test  prism  in  the  opposite  direction ;  then 
if  all  the  unfavorable  symptoms  be  aggravated, 
we  have  some  assurance  at  least  that  the  last 
position  was  wrong,  and  therefore  we  return  to 
the  first  position  and  proceed  with  caution  and 
patience. 

During  all  tests  the  color  of  the  skin,  the 
action  of  the  heart,  the  warmth  of  the  hands  and 
feet  and  the  general  feelings  of  the  patient  should 
be  carefully  inquired  into,  for  sometimes  a  spasm 
will  turn  the  eye  8  deg.  or  lo  deg.  in  a  direction 
opposite  to  the  short  muscle.  The  only  safe  way 
of  discovering  this  spasm  is  to  note  the  symptoms 
of  the  patient  as  we  proceed,  exercising  at  all 
times  the  greatest  care  in  drawing  our  conclu- 
sions ;  for  a  pleasant  stimulated  feeling  sometimes 
follows  the  turning  of  the  eye  in  the  direction  of 
the  spasm  ;  but  such  a  change  is  of  a  temporary 
character,  and  a  few  hours  or  a  few  repetitions  of 
the  experiment  will  suffice  for  the  manifestation 
of  unfavorable  symptoms.  Again,  when  we  are 
developing  in  the  proper  direction,  disturbances 
of  a  transitory  character  will  sometimes  arise,  but 
these  are  not  an  aggravation  of  the  symptoms  of 
the  disease.  They  should  always  be  subdued. 
If  we  are  really  repressing,  the  probability  is  that 
the  temporary  disturbances  arising  are  all  new 
symptoms.  The  exceptions  exceed  any  general 
rule  that  can  be  laid  down   in  this   practice,   and 


i62  THE  EYE  IN  ITS 

each  case  presents  features  that  require  individual 
care. 

Sometimes  we  may  be  fortunate  enough  to 
have  such  marked  changes  ensue  from  repression 
that  there  will  be  little  uncertainty.  I  have  seen 
it  reduce  the  heart's  action  within  one  hour  from 
120  to  65,  where  on  the  removal  of  the  glasses  the 
heart  in  a  short  time  would  increase  to  its  former 
standard,  and  again  with  the  glasses  be  reduced. 
I  have  repeatedly  seen  persistent  pains  in  the 
back,  the  ovaries,  the  stomach  and  various  other 
parts  relieved  within  an  hour  or  two,  and  repro- 
duced by  the  removal  of  the  glasses  or  the 
reversal  of  the  prisms.  I  have  seen  the  reverse 
position  produce  a  nervous  chill.  There  cer- 
tainly is  as  much  mental-suggestion  in  one  posi- 
tion of  the  prism  as  the  other. 

There  may  be  fully  as  much  consciousness  of 
effort  in  a  repressive  strain  that  suspends  impulse 
as  if  it  were  a  direct  one  requiring  innervation  to 
sustain  it. 

During  repression,  when  the  excessive  impulse 
has  been  partially  suspended,  it  will  sometimes 
suddenly  return,  and  with  it  the  disturbing  and 
annoying  symptoms  of  the  disease  will  be  aggra- 
vated, but  we  must  not  be  misled  by  this,  for  it 
is  a  thing  of  frequent  occurrence.  Abnormal 
innervation  is  very  obstinate  and  is  repressed 
slowly.     The  longer  repression  is  persisted  in,  the 


RELATION  TO  HEALTH.  163 

less  likely  is  spasm  to  occur ;  but,  when  it  does, 
the  patient  is  unable  to  fuse  any  longer  under  the 
prism  which  was  worn  just  before  its  return.  In 
this  case  the  prism  should  be  reduced  to  a  pos- 
sible point  of  fusion  again,  for  if  the  full 
amount  is  continued  the  fusion  stimulus  is  lost 
and  the  spasm  runs  riot ;  but  if  the  prism  is  re- 
duced to  that  point  where  fusion  can  take  place 
again,  the  spasm  will  be  held  more  or  less  under 
subjection,  after  which  we  can  gradually  increase 
the  prism  again  to  the  point  where  the  spasm  oc- 
curred, and  in  time  get  beyond  it.  These  annoy- 
ances occur  far  short  of  full  development,  with 
only  2  deg.,  3  deg.  or  4  deg.  of  prism,  where 
later  the  same  case  may  develop  1 5  deg.  or  20 
deg.  with  much  improvement.  In  excessively 
nervous  people  these  spasms  are  quite  frequent, 
but  when  we  have  discovered  beyond  a  perad- 
venture  where  the  abnormal  innervation  is, 
we  can  force  our  position  against  all  adverse 
symptoms. 

As  THE  CILIARY  SPASM  IN  HYPEROPIA  FRE- 
QUENTLY PASSES  BEYOND  THAT  POINT  WHERE  PERFECT 
VISION  IS  THE  RESULT,  AND  TOO  HIGH  A  REFRACTION 
OBTAINS  (myopia),  SO  WE  MAY  AS  OFTEN  EXPECT 
THAT  THE  LONG  MUSCLES,  IN  THEIR  EFFORT  TO 
OVERCOME  SOME  ANATOMICAL  DEFECT,  HAVE 
EXCEEDED  THE  INTENTION  OF  THEIR  EFFORT  TO 
CORRECT,  AND    TURNED    THE    EYES    IN    A   DIRECTION 


164  THE  EYE  IN  ITS 

OPPOSITE     TO     THE     SHORT     MUSCLE.          ThIS     IS     A 
REVERSE-MANIFEST  EYE-STRAIN  AND  VERY  COMMON. 

When  abnormal  nerve-impulses  have  become 
thoroughly  established  through  the  medium  of 
defects  in  the  visual  apparatus,  and  loss  of  sight 
occurs,  all  means  of  repression  through  the 
medium  of  the  eyes  is  lost.  If  abnormal  impulses 
depended  upon  a  stimulus  for  their  continuance, 
blindness  would  be  the  end  of  them;  but  inasmuch 
as  these  impulses  become  firmly  and  fixedly 
established,  they  will  not  suspend  themselves 
without  the  interposition  of  repressive  strain. 

When  eyes  deviate  from  parallelism,  the 
deflection  is  due  to  one  of  two  causes,  either  a 
short  muscle  or  a  spasm.  Again,  the  spasm  may 
be  due  to  an  effort  to  correct  a  short  muscle  or  to 
fixed  abnormal  nerve-impulses  that  are  the  out- 
growth of  long  continued  strained  positions  of 
the  eyes,  as  in  writing,  reading,  painting,  mining, 
watchmaking  and  all  kinds  of  labor  where  the  eyes 
are  in  constant  use  at  the  near  point,  or  in  some 
unnatural  position. 


RELATION  TO  HEALTH,  165 


XL 


ORTHOPHORIA:  Regular  or  correct  tending 
of  the  optic  axes. 

Heterophoria:  Different  tending  of  the  optic 
axes. 

Esophoria:     Inward  tending  of  the  optic  axes. 

Exophoria:  Outward  tending  of  the  optic  axes. 

Hyperphoria:  Upward  tending  of  the  optic 
axes. 

Cataphoria:  Downward  tending  of  the  optic 
axes.* 

The  above  terms  have  heretofore  been  used 
in  a  relative  sense;  namely,  esophoria,  a  relative 
tending  of  the  optic  axes  toward  each 
other;  exophoria,  a  relative  tending  from 
each  other;  hyperphoria,  in  which  the  one 
axis  is  relatively  higher  than  the  other; 
and  cataphoria,  in  which  it  is  lower.  A  person 
with  but  one  eye  may  have  any  one  of  the  above 
conditions.  The  optic  axis  of  a  single  eye  may 
turn  inward,  outward,  upward  or  downward  from 
what  would  be  a  normal  position,  giving  rise  to 
considerable  disturbance  and  strain,  especially  if 

*We  are  indebted  to  Dr.  George  T.  Stevens,  of  New  York,  for  the 
above  nomeiiclature. 


1 66  THE  EYE  IN  ITS 

a  glass  is  worn,  in  which  case  the  clearest  vision 
is  sought  through  its  center,  necessitating  the 
holding  of  the  eye  in  a  normal  position.  If  a 
glass  is  not  worn,  the  head  is  usually  thrown  into 
that  position  which  most  relieves  the  strain.  If 
the  upper  muscle  is  short,  the  chin  is  thrown 
down  and  the  forehead  forward;  if  the  lower,  the 
chin  is  thrown  up  and  the  head  back;  but  if  the 
short  muscle  is  the  outer  or  the  inner,  the  eye 
rather  than  the  head  is  usually  turned  so  as  to 
relieve  the  strain.  These  conditions  are  quite 
common  in  persons  with  but  one  eye,  so  I  think 
it  would  be  well  to  discriminate  between  relative 
and  individual  heterophoria. 

By  considering  only  the  relative  position  of 
the  two  eyes,  we  are  likely  to  overlook  some 
grave  defect  in  the  ocular  muscles,  for  it  is  pos- 
sible for  both  of  the  superior  or  both  of  the  in- 
ferior muscles  to  be  short  in  connection  with  a 
relative  deviation  or  a  relative  balance.  Short- 
ness of  the  external  of  one  eye  and  the  internal 
of  the  other  may  exist,  and  still  a  relative  balance 
be  maintained.  We  may  often  fall  short  in  our 
investigation  by  taking  into  consideration  only 
the  relative  position  of  the  lines  of  sight.  There 
are  cases  that  should  require  months  of  careful  in- 
vestigation before  safe  conclusions  can  be  drawn. 

Defective  length  and  defective  attachment  of 
the  oblique  muscles  will  sometimes  be  found.     I 


RELATION  TO  HEALTH,  167 

have  met  with  two  cases  of  this  kind  in  which 
there  was  a  very  manifest  turning  of  the  ball  on 
its  antero-posterior  axis  when  an  effort  was  made 
to  move  the  eye  laterally.  With  the  assistance 
of  Dr.  C.  S.  Hamilton,  of  Toronto,  I  operated  on 
one  of  these  cases  by  making  a  complete  division 
of  the  superior  oblique  muscle  at  its  ocular 
attachment  with  the  result  that  the  twisting 
movements  of  the  eye  ceased  and  there  was 
very  marked  improvement  in  the  nervous  symp- 
toms from  which  the  patient  had  suffered  previ- 
ously. 

From  the  fact  of  the  convergence  and  diver- 
gence necessary  for  the  accommodations  for  vari- 
ous distances,  defects  are  much  more  likely  to  be 
manifest  in  the  external  and  internal  muscles  than 
in  the  superior  and  inferior  muscles,  because 
during  their  functions  there  is  never  any  devi- 
ation from  a  horizontal  plane.  Both  eyes 
move  upward  and  downward  simultaneously  and 
equally,  and  through  such  constant  use  the 
nerve-impulses  to  these  muscles  establish  a  very 
fixed  horizontalizing  tendency. 

DIFFUSION     TESTS. 

Place  a  red  or  highly  colored  plain  glass  before 
one  eye.  The  dissimilarity  in  color  in  some  cases 
will  disclose  a  lack  of  parallelism  of  the  lines  of 
sight. 


i68  THE  EYE  IN  ITS 

A  plus  lens  of  lo  dioptres,  more  or  less, 
covered  with  a  disc  with  a  small  opening  in  its 
center  which  permits  one  eye  to  see  only  directly 
through  the  center  of  the  lens,  renders  two  lights 
so  dissimilar  in  shape  that  diffusion  will  some- 
times occur. 

The  Maddox  rod  placed  before  one  eye  dis- 
torts a  light  into  a  long  beam  of  light,  while  the 
same  object  seen  by  the  other  eye  retains  its 
natural  shape,  and  any  manifest  deviation  can  be 
discovered. 

Another  ingenious  instrument  for  creating  dif- 
fusion, is  Mr.  Brayton's  Optomyometer,  which 
consists  of  two  hollow  tubes  about  eighteen  inches 
in  length,  through  which  the  eyes  of  the  patient 
look  at  a  plain,  smooth  curtain  or  surface.  When 
diffusion  takes  place  two  round  spaces  appear. 
These  cylinders  or  barrels  are  so  arranged  that  they 
can  then  be  moved  from  their  parallelism  into  a 
position  that  brings  the  two  objects  together,  the 
degrees  of  deviation  being  measured  by  a  pointer 
on  the  instrument.  The  fusion  stimulus  can  be 
decreased  in  this  instrument  by  adding  any  one 
of  the  above  mentioned  three  implements  to  one 
of  the  eye  barrels. 

Direct  the  patient  to  look  steadily  at  a  light 
or  some  fixed  object,  covering  one  eye  with  a 
card.  After  a  minute  or  two,  suddenly  change 
the  card  over  to  the  opposite  eye  and  inquire  of 


RELATION  TO  HEALTH.  169 

the  patient  if  any  apparent  change  occurred  in  the 
position  of  the  light.  Sometimes  by  this  test  we 
are  able  to  see  the  eye  move  as  it  fixes  itself  on 
the  light  when  the  card  is  changed. 

Place  before  the  eyes  enough  prism,  base  in, 
to  create  diplopia,  being  careful  that  the  axes  of 
the  prisms  are  horizontal  and  the  head  of  the 
patient  erect,  and  a  single  light  or  object  appears 
as  two,  the  object  on  the  right  side  being  seen  by 
the  right  eye,  and  that  on  the  left  by  the  left.  If 
either  object  appears  lower  than  the  other,  the 
indication  is  that  the  eye  on  the  same  side  is 
higher. 

Place  sufficient  prism,  base  down,  before  one 
of  the  eyes  to  create  diplopia,  being  careful  that 
the  axes  of  the  prisms  are  vertical  and  the  head 
erect,  thus  making  a  single  light  or  object  appear 
as  two.  If  the  lights  are  relatively  vertical,  there 
is  an  apparent  balance  ;  but  if  with  the  prism 
base  down,  before  the  left  eye  the  upper  object  is 
to  the  left,  there  is  a  manifest  convergence  of  the 
eyes ;  if  to  the  right,  a  divergence. 

Two  prisms  held  together,  base  to  base,  by  an 
eyeglass  rim,  if  placed  before  the  center  of  the 
pupil  of  the  eye,  with  their  axes  horizontal,  create 
for  that  eye  two  apparent  objects.  The  other  eye 
will  see  the  real  object  between  these  two,  if  the 
prisms  are  of  sufficient  strength.  If  the  middle 
object  seen  with  the  uncovered  eye  is  higher  than 


170  THE  EYE  IN  ITS 

the  other  two,  then  that  eye  is  lower ;  and  con- 
versely, if  the  object  is  lower  the  eye  is  higher. 
If  the  prisms  are  not  of  sufficient  strength,  the 
uncovered  eye  may  fuse  its  object  with  one  of  the 
other  two  images.  By  now  turning  the  axes  of 
this  prism  vertical,  the  two  apparent  objects  are 
seen  by  one  eye,  one  above  the  other,  and  any 
deviation  of  the  middle  or  third  object  indicates 
a  deviation  in  the  lateral  muscles. 

This  double  prism  test  has  no  advantage  over 
the  single  prism  test,  if  indeed  it  does  not  possess 
one  disadvantage,  namely  that  of  multiplying  the 
objects ;  for  the  fact  of  there  being  two  exactly  in 
the  horizontal  plane  offers  a  higher  stimulus  for 
the  other  eye  to  horizontalize,  or  bring  its  image 
into  the  vertical  plane.  There  being  two  appar- 
ent spots  exactly  vertical,  the  stimulus  to  verti- 
calize  by  the  lateral  muscles  is  emphasized.* 


*  See  horizontalizing  and  verticalizing  tendencies,  pages 

37  and  38. 


RELATION  TO  HEALTH,  171 


XII. 

THE  superior  oblique  muscle  receives  its  nerve- 
supply  through  the  Fourth  Cranial  nerve ; 
the  external  rectus,  through  the  Sixth ;  the  supe- 
rior, inferior,  internal  rectus,  both  obliques  and 
the  ciliary,   through  the  Third. 

That  various  parts  receive  their  nerve-supply 
from  the  same  nerve  does  not  imply  that  their 
functions  are  necessarily  similar,  or  that  the  gov- 
erning nerve-centers  are  in  the  same  locality ;  for 
two  fibrilla  in  a  nerve,  lying  side  by  side,  may 
have  the  most  widely  separate  origin  possible  in 
the  nerve-centers. 

Considered  individually,  the  actions  of  the 
long  muscles  of  the  eye  are  as  follows  :  The  ex- 
ternal rectus  turns  the  eye  outward ;  the  internal 
inward ;  the  superior,  upward  and  slightly  inward 
with  a  tortional  movement  of  the  upper  aspect  of 
the  eye  toward  the  nose.  The  inferior  moves  the 
eye  downward,  slightly  inward  with  a  slight  tor- 
tion  of  the  upper  aspect  of  the  eye  from  the  nose. 
The  superior  oblique  makes  a  tortion  of  the  upper 
aspect  of  the  eye  toward  the  nose,  with  a  slight 
movement  of  the  optic  axes  outward  and  down- 
ward ;  the  inferior  oblique    produces    tortion    of 


172  THE  EYE  IN  ITS 

the  upper  aspect  from  the  nose,  with  a  small 
tendency  to  turn  the  optic  axes  outward  and 
upward. 

Considered  relatively,  there  are  four  antagon- 
istic sets  of  muscles :  First,  the  superior  and 
inferior  recti ;  second,  the  external  and  internal ; 
third,  the  superior  and  inferior  obliques ;  fourth, 
the  superior  and  inferior  recti  as  antagonized  by 
the  superior  and  inferior  obliques.  The  latter  set 
slightly  diverges  the  optic  axes,  and  the  former 
set  slightly  converges  them. 

There  are  six  sets  of  synchronously  acting 
muscles :  First,  the  superior  recti  turn  both  eyes 
upward ;  second,  the  inferior  recti  move  them 
downward  ;  third,  the  right  external  and  left  in- 
ternal recti  turn  both  eyes  to  the  right ;  fourth, 
the  left  external  and  right  internal  recti  turn  both 
eyes  to  the  left ;  fifth,  the  superior  and  inferior 
obliques  of  the  right  eye,  acting  together,  in  con- 
nection with  the  superior  and  inferior  recti  of  the 
left  eye,  have  a  tendency  to  turn  both  eyes  slightly 
to  the  right;  sixth,  the  superior  and  inferior  ob- 
liques of  the  left  eye,  acting  synchronously  with 
the  superior  and  inferior  recti  of  the  right  eye, 
turn  the  eyes  slightly  to  the  left. 

A  still  further  secondary  action  takes  place  as 
follows:  When  the  eye  is  turned  upward  so  that 
the  relative  equator  of  the  eye-ball  is  thrown 
below  the  parallelism  of  the  internal  and  external 


RELATION  TO  HEALTH,  173 

recti,  a  contraction  of  these  muscles  will  assist  in 
turning  the  eye  upward.  Conversely,  when  the 
eye  is  turned  downward  so  that  its  equator  lies 
above  the  line  of  these  muscles,  their  contraction 
will  assist  in  turning  the  eye  downward.  When 
the  eye  is  turned  outward  so  that  its  equator  lies 
inside  the  line  of  the  superior  and  inferior  recti, 
their  contraction  would  assist  in  turning  the  eye 
outward.  When  the  eye  is  turned  inward  so  that 
the  equator  lies  outside  of  the  line  of  the  superior 
and  inferior  recti,  their  contraction  would  assist 
in  turning  the  eye  inward. 

In  taking  into  consideration  the  chief  action  of 
any  one  or  more  muscles,  the  above  associated 
movements  should  always  be  understood  and 
considered. 


174  THE  EYE  IN  ITS 


XIII. 

ESOPHORIA,  or  a  tendency  to  a  convergence 
of  the  optic  axes,  is  the  most  deceptive  and 
troublesome  condition  with  which  we  have  to 
deal,  and  from  its  very  nature  we  can  see  how 
unreliable  all  diffusion  tests  are,  as  indicating  the 
true  conditions. 

We  will  suppose  a  case  where  the  lengths  of 
the  various  long  muscles  of  the  eye  are  such  that, 
without  effort  the  axes  of  the  two  eyes  are  per- 
fectly parallel  at  a  distance  of  twenty  feet  or  more. 
The  muscles,  in  performing  their  functions  at  an 
infinite  distance  make  their  movements  in  various 
directions  synchronously,  the  superior  muscles 
turning  both  eyes  upward,  and  the  inferior  mus- 
cles turning  them  downward.  Turning  to  the 
right,  the  right  external  and  the  left  internal  act 
together,  and  the  necessary  innervation  is  com- 
pensated for  when  the  two  eyes  are  directed  to 
the  left ;  for  then  the  left  external  and  the  right 
internal  require  an  amount  of  innervation  equiva- 
lent to  that  required  for  the  movement  in  the 
other  direction. 

Supposing  the  various  inclinations  of  the  head 
to  the  right  and  to  the  left  to  be  of  nearly  equal 


RELATION  TO  HEALTH.  175 

frequency,  the  oblique  muscles  will  also  be  uni- 
formly exercised.  Thus  in  the  various  movements 
of  the  eye  at  a  distance,  there  is  a  tendency  to 
establish  more  or  less  of  an  equilibrium  in  the 
nerve-impulses  that  contract  the  various  muscles ; 
but  when  the  vision  is  fixed  upon  some  object  at 
a  near  point,  as  is  necessary  in  reading,  writing 
and  in  the  pursuit  of  various  mechanical  arts,  the 
internal  rectus  muscles  receive  an  amount  of 
nerve-force  necessary  to  break  the  parallelism  of 
the  infinite  distance,  and  turn  the  eyes  toward 
each  other.  The  repeated  exercise  of  the  internal 
muscles  has  a  constant  tendency  to  develop  their 
power,  and  there  is  no  counter  movement  of  the 
eyes  in  which  the  opposing  muscles  have  any 
opportunity  for  a  like  development.  It  is  for  this 
reason  that  we  always  find  the  internal  muscles 
much  stronger  than  the  external ;  but  the  differ- 
ence in  strength  between  the  internal  and  external 
muscles  has  no  tendency  to  cause  the  eyes  to 
deviate  from  perfect  parallelism  at  a  distance. 
Under  normal  conditions  there  remains  the  ability 
to  suspend  the  nerve-impulse  that  gives  greater 
strength  to  the  internal  muscles.  When  the  eyes 
are  removed  from  the  near  to  the  remote  point 
the  relaxation  is  a  negative  act  yet  a  normal  func- 
tion. There  is  no  contention  between  the  inter- 
nal and  the  external  muscles.  Under  normal 
conditions,  the  function  of  suspending  nerve-im- 


176  THE  EYE  IN  ITS 

pulse  exists  in  all  the  ocular  muscles ;  when  cer- 
tain muscles  contract  to  perform  some  office  their 
opposites  relax  to  assist  them.  In  the  fullest 
sense  this  suspension  of  nerve-impulse  is  probably 
not  absolute.  Just  sufficient  impulse  continues  to 
give  the  eyes  a  steady  position ;  but,  where  the 
employment  of  the  eyes  has  been  such  as  to 
necessitate  their  use  at  the  near  point  constantly, 
from  morning  until  night,  day  after  day  (as  in  the 
case  of  an  inveterate  reader  or  writer,  or  an  arti- 
san with  his  work  constantly  close  to  his  eyes), 
the  nerve-impulses  of  the  internal  muscles  are 
almost  constant,  with  little  or  quite  infrequent  per- 
iods of  relaxation;  thus  the  impulse  becomes  such 
a  fixed  and  constant  quantity  that  ultimately  there 
is  an  inability  to  suspend  it  entirely.  Such  eyes, 
when  examined  at  a  distance  of  twenty  feet  or 
more,  show  a  positive  tendency  toward  conver- 
gence, while  at  the  near  point  we  may  find  a  bal- 
ance, a  convergence,  or  even  a  tendency  to  diver- 
gence, as  a  result  of  the  excessive  abnormal 
innervation. 

By  diffusion  tests  a  convergence  may  appear 
where  the  external  and  internal  muscles  are  of 
proper  length,  when  it  is  apparent  esophoria ;  or  it 
may  appear  where  the  externals  are  short,  in  which 
case  it  is  a  reverse  manifestation;  or  it  may  appear 
where  the  internals  are  short.  Of  the  three  con- 
ditions, the  last  is  the  least  likely  to  be  the  fact. 


RELATION  TO  HEALTH.  177 

EsoPHORiA  is  the  most  confusing  and  obstinate 
condition  with  which  we  have  to  deal.  The 
above  demonstrates  how  dangerous  it  is  to  rely  on 
any  diffusion  test  as  an  indication  of  the  true 
anatomical  condition  of  the  ocular  muscles ;  and 
it  is  not  strange  that,  by  so  doing,  many  have  been 
thrown  into  doubt  and  confusion  as  to  the  impor- 
tance of  this  field  of  work.  Repression,  in  which 
symptoms  are  our  chief  guide,  is  the  only  method 
of  safely  determining  whether  the  diffusion  tests 
have  given  a  true  or  false  indication  of  the  condi- 
tion of  the  muscles.  The  majority  of  cases  of 
manifest  esophoria  are  reverse  manifestations,  or 
due  to  spasm.  When  esophoria  exists  at  the  far 
point,  and  exophoria  at  the  near,  it  is  pretty  safe 
to  conclude  that  it  is  not  true  esophoria. 

EXOPHORIA. 

Of  all  defects,  this  is  undoubtedly  the  most 
common.  The  tendency  of  the  optic  axes  to 
diverge  may,  as  in  other  muscular  defects,  be  due 
to  shortness  of  the  external  muscles,  or  it  may 
be  apparent  exophoria,  due  to  spasm,  receiving 
its  initial  source  of  irritation  from  a  latent  defect 
in  some  one  of  the  other  muscles,  more  usually  a 
superior  or  inferior.  Or,  it  may  possibly  be  a 
reverse  manifestation.  In  short,  strain  in  any  one 
of  the  ocular  muscles  may  give  rise  to  a  spasm 
and  apparent   defect  in  any  of  the  others,   and 


lyS  THE  EYE  IN  IIS 

repression  is  the  only  method  that  will  determine 
with  any  safety  the  actual  state  of  affairs.  When- 
ever exophoria  exists  at  the  near  point,  I  always 
endeavor  by  repression  to  develop  an  exophoria 
and  in  most  instances  succeed.  Also  in  some 
cases  where  esophoria  exists  at  the  near  point, 
repression  will  develop  a  true  exophoria,  the  cer- 
tainty of  which  is  rendered  positive  by  the  physi- 
cal relief  which  accompanies  the  development. 

HYPERPHORIA  AND    CATAPHORIA. 

A  greater  amount  of  defect  is  likely  to  be 
latent  in  the  superior  and  inferior  than  in  the 
external  and  internal  ocular  muscles,  for  the  latter 
in  the  performance  of  their  various  functions  are 
alternately  converging  and  diverging  their  optic 
axes,  while  the  superior  and  inferior  never  cause 
any  relative  change  in  the  optic  axes,  upward  or 
downward,  during  their  work.  Whatever  position 
they  assume,  the  optic  axes  never  deviate  rela- 
tively from  a  horizontal  plane  ;  consequently  the 
impulses  to  the  superior  and  inferior  muscles 
become  more  obstinately  fixed,  and  defects  in 
these  muscles  are  less  likely  to  manifest  them- 
selves. If  the  superior  muscle  of  one  of  the  eyes 
is  short,  and  the  inferior  muscle  of  the  same  eye 
is  sufficiently  innervated  it  will  draw  the  eve  down 
into  line  with  its  fellow.  Day  after  day  nerve- 
impulse   is   sent  to   the  inferior  muscle,  contract- 


RELATION  TO  HEALTH.  179 

ing  it  and  holding  the  eye  in  place.  During 
months  and  years  this  process  goes  on  until  the 
nerve-centers  become  accustomed  to  manufactur- 
ing and  sending  out  this  excessive  nerve-impulse, 
and  perfect  vision  is  performed.  At  the  age  of 
thirty,  more  or  less,  the  short  muscle,  having 
been  constantly  kept  on  the  stretch,  is  naturally 
weak  and  undeveloped.  Its  length  is  greater  than 
normal  conditions  would  have  left  it.  It  has 
always  been  stretched  by  the  opposite  muscle, 
which  has  contracted  to  draw  the  eyes  into  line, 
while  the  contracted  or  innervated  muscle  is 
over-developed,  having  received  for  thirty  years 
an  excessive  amount  of  nerve-impulse  to  perform 
its  work,  an  amount  of  motive-force  for  which  the 
nerve-centers  were  not  originally  intended  to  be 
drawn  upon.  In  time,  through  differentiation, 
the  nerve-centers  become  accustomed  to  generat- 
ing and  sending  out  this  excessive  amount  of 
motive-force  for  the  purpose  of  maintaining  per- 
fect vision ;  thus  the  impulse  becomes  a  fixed 
one  requiring  no  further  stimulant  to  call  it  forth. 
It  becomes  fixed  in  sufficient  force  to  establish  a 
balance  between  the  two  eyes  even  when  prisms 
or  other  diffusion  tests  are  resorted  to  for  the  pur- 
pose of  ascertaining  if  one  eye  is  higher  or  lower 
than  the  other.  Although  we  have  created  dip- 
lopia, the  eye  does  not  turn  toward  the  short 
muscle,  because  the  nerve-impulse  that  opposes  it 


i8o  THE  EYE  IN  ITS 

pulls  just  as  hard  as  the  short  muscle  does.  It 
has  become  an  absolutely  fixed  impulse  requiring 
no  stimulus  to  generate  it.  It  is  as  fixed  as  the 
impulse  that  carries  on  the  action  of  the  heart  or 
the  functions  of  the  liver.  Under  these  circum- 
stances it  is  useless  to  expect  any  diffusion  test  to 
reveal  a  muscular  defect  if  it  is  present. 

From  this  excessive  demand  for  motive-force 
irritation  frequently  results  in  the  centers  that  are 
furnishing  it;  the  impulse  becomes  stronger  than  is 
necessary  to  hold  the  eye  down  in  line  ;  and,  when 
diffusion  tests  are  made,  it  is  pulled  below  or  in  a 
direction  opposite  the  short  muscle  (reverse  man- 
ifestation). To  attempt  to  correct  such  a  defect 
as  manifested  by  diffusion  would  increase  the  ner- 
vous disturbance.  Repression  in  connection  with 
symptom  tests   is  the  only  safe  procedure. 

During  repression  by  crowding  on  all  the  prism 
that  the  eyes  will  fuse  under  we  cannot  expect 
this  short  muscle  in  a  few  weeks  or  even  months 
to  assume  its  normal  length.  Will  it  be  as  short 
as  it  would  have  been  had  it  never  been  stretched  ; 
or  would  the  opposite  or  excessively  innervated 
long  muscle  under  this  process  become  stretched 
to  a  length  that  is  in  any  way  equivalent  to  the 
stretching  that  has  taken  place  in  the  short  muscle 
during  a  period  of  thirty  years  ?  This  question  is 
a  sufficient  answer  in  itself. 

When  we  have  discovered  that  a  defect  exists 


RELATION  TO  HEALTH.  iSi 

in  the  superior  or  inferior  rectus  muscle,  it  is 
important  to  determine  whether  it  is  hyperphoria 
or  cataphoria ;  for  to  select  the  superior  muscle  as 
being  invariably  the  defective  one  will  prove 
wrong.  Dr.  Stevens  has  pointed  out  the  fact  that 
the  head  is  usually  tilted  toward  the  shoulder 
opposite  the  eye  which  tends  the  higher  ;  in  other 
words,  it  is  tilted  toward  the  shoulder  on  the  side 
next  to  the  eye  which  tends  the  lower,  or  would 
in  the  absence  of  innervation.  Now,  it  is  very 
important  to  determine  whether  this  tendency  is 
due  to  a  short  inferior  muscle  in  one  eye  or  a 
short  superior  in  the  other.  This  I  think  can 
safely  be  determined  by  noting  another  position 
of  the  head.  If,  in  connection  with  the  side  incli- 
nation, the  head  is  constantly  thrown  backward 
and  the  chin  elevated,  the  inferior  muscle  will 
prove  to  be  short ;  but  if  it  is  inclined  forward 
with  the  chin  resting  well  down  toward  the  breast 
bone,  it  is  evident  that  the  superior  muscle  is 
short.  These  positions  should  be  carefully  noted 
during  repression  tests,  and  if  the  chin  is  thrown 
up  and  the  head  back,  the  greater  amount  of  our 
repression  prism  may  be  put  on,  base  up,  which 
will  have  a  tendency  to  lower  the  chin.  If  the 
head  is  ducked  forward,  we  may  put  on  the  greater 
amount  of  repression  prism,  base  down,  which 
will  have  a  tendency  to  raise  the  chin  into  a  more 
normal  position. 


i82  THE  EYE  IN  ITS 

Before  operating  on  an  eye  the  oculist  should 
determine  several  important  things.  First,  is  the 
patient's  condition  a  serious  one,  and  does  it  in  a 
great  measure  depend  on  eye  defects  ?  The 
result  of  our  examination  by  repression  will 
determine  this  for  us,  for  if  prominent  symptoms 
can  in  this  way  be  subdued,  we  have  reason  to 
feel  encouraged.  Next,  have  the  tests  developed 
a  sufficient  defect  in  the  ocular  muscles  to  warrant 
an  operation?  If  the  defective  muscle  is  a  supe- 
rior or  inferior,  and  the  repression  has  not  dis- 
closed more  than  lo  deg.  or  12  deg.,  treatment 
with  prisms  may  be  the  more  practicable.  This 
in  no  way  relates  to  defects  as  developed  by  diffu- 
sion tests.  In  a  case  in  which  no  more  than  lo 
deg.  or  12  deg.  have  been  developed  by  repres- 
sion, partial  tenotomy  might  possibly  bring  the 
optic  axes  up  or  down  into  line ;  but  it  would  not 
leave  as  true  normal  conditions  as  prisms.  A 
partial  tenotomy  in  which  three-fourths,  more  or 
less,  of  a  tendon  is  divided  leaves  the  other  one- 
fourth  of  the  tendon  on  the  stretch.  It  offers 
less,  yet  a  proportionate  amount  of  resistance. 
If  it  permits  the  eye  to  turn  sufficiently  far,  the 
cut  fraction  may  assume  in  a  small  measure  the 
functions  of  a  normal  muscle,  but  this  is  forever 
out  of  the  question  with  the  uncut  portion. 

If  the  muscles  are  so  attached  to  the  ball  that 
one  of  the  eyes  deviates   from   its   fellow  20  deg., 


RELATION  TO  HEALTH.  183 

when  the  eye  is  in  this  position  the  muscles  are  of 
proper  length  and  all  innervation  will  be  sus- 
pended ;  but  when  this  eye  is  moved  into  line 
with  its  mate  one  muscle  is  too  short  and  the 
other  too  long ;  consequently,  if  the  deviation  is 
within  the  practical  limits  of  the  use  of  prisms, 
the  eye  is  rotated  into  that  position  in  which  both 
muscles  are  of  proper  length,  and  from  this  posi- 
tion the  associated  movements  of  the  eye  will  call 
upon  each  muscle  for  its  proportionate  share  of 
normal  function. 

If  primarily  an  eye  had  a  tendency  to  deviate 
in  any  direction — for  illustration,  outward  one- 
fourth  of  an  inch — and  innervation  to  the  opposite 
muscle  has  lined  the  eyes  up  and  held  them  in 
proper  position  for  a  space  of  years,  during  this 
time  the  short  muscle  has  been  stretched  to  one- 
fourth  of  an  inch  greater  than  its  natural  length, 
while  the  long  muscle,  by  contraction,  has  taken 
up  one-fourth  of  an  inch  of  excess  in  length. 
Under  these  conditions  the  short  muscle  is  longer, 
and  the  long  muscle  shorter  one-fourth  of  an  inch 
than  they  would  have  been  had  their  lengths  been 
normal  primaril3^  Therefore,  under  these  circum- 
stances, a  lengthening  of  the  short  muscle  by 
tenotomy  does  not  by  any  means  fulfill  all  the 
requirements  of  the  case.  It  is  true  that  the  short 
muscle  needs  greater  length  ;  but,  for  a  normal 
position  of  the  eye,  we  must  remember,  also,  that 


i84  THE  EYE  IN  ITS 

the  opposite  muscle  has  always  been  too  long; 
and  if  we  relieve  the  strain  in  the  short  muscle, 
thus  allowing  the  eye  to  maintain  a  normal  posi- 
tion with  less  work,  the  long  muscle  on  the  oppo- 
site side  must  contract  upon  itself  by  excessive 
innervation  a  sufficient  amount  to  shorten  itself 
one-fourth  of  an  inch  before  it  can  assume  normal 
functions ;  and  the  necessity  of  shortening  this 
muscle  to  avoid  this  innervation  is  oftentimes  as 
necessary  as  the  lengthening  of  the  short  muscle. 
When  a  short  muscle  has  been  stretched  by  its 
vis-a-vis  for  many  years,  and  an  operation  is  per- 
formed which  gives  it  greater  length  and  removes 
the  stress  upon  it,  the  short  muscle  that  has  been 
stretched  begins  to  shorten  itself  after  the  opera- 
tion by  assuming  a  normal  activity  that  it  never 
before  had  an  opportunity  to  assume.  After  the 
operation  the  short  muscle  has  a  chance  to  act  for 
the  first  time  in  its  existence.  It  continues  to 
shorten  week  after  week,  month  after  month,  and 
will  usually  take  up  several  degrees  of  deviation 
made  in  the  opposite  direction  by  the  operation. 
This  process  of  shortening  continues  to  such  an 
extent  that  in  variable  lengths  of  time  it  will 
obliterate  double  v'ision  to  the  amount  of  lO  deg. 
to  20  deg.,  and  often  a  deviation  in  the  original 
direction  will  ultimatelv  present  itself  again,  re- 
quiring still  further  correction  by  a  repetition  of 
the  operation.      Often   it   is   deemed  necessary  to 


RELATION  TO  HEALTH.  185 

lose  a  limb  to  save  life,  and  the  little  temporary 
discomforts  and  inconveniences  resulting  from  re- 
pression should  be  looked  upon  in  the  same  light. 
After  external  tenotomies,  double  vision  will 
sometimes  continue  to  exist  for  several  months,  in 
looking  to  the  extreme  right  or  left,  a  condition 
that  need  not  annoy  the  patient  at  all.  This  sel- 
dom follows  tenotomy  of  the  internal  muscle. 
With  care  in  developing  fully,  and  continuance 
of  the  repression  under  prisms  for  several  weeks, 
complete  tenotomy  can  be  performed  in  the  ma- 
jority of  cases  without  the  occurrence  of  double 
vision.  If  the  development  has  been  high  and 
double  vision  does  occur,  it  soon  corrects  itself 
by  the  normal  shortening  of  the  cut  muscle. 

Never  should  an  operation  be  performed  until 
the  physician  is  absolutely  certain  that  he  has 
ascertained  which  muscle  is  short.  An  oversight 
of  this  kind  might  occasion  very  serious  conse- 
quences to  the  patient. 

From  the  above  conditions  we  can  see  that  the 
results  will  be  but  temporary  in  an  effort  merely 
to  balance  the  optic  axes  where  there  has  been  a 
manifest  deviation.  If  we  balance  them  for  the 
time  being,  the  process  of  shortening  the  already 
short  muscle  will  in  time  tend  to  reproduce  devia- 
tion in  the  same  direction,  and  it  will  keep  on 
doing  so  from  time  to  time,  necessitating  many 
operations;    indeed     I    have     known     as     many 


1 86  THE  EYE  IN  ITS 

as  twenty.  Life  is  too  short  for  such  a 
procedure,  when  by  repression  we  can  more  rapidly 
discover  the  latent  defects.  In  applying  the 
maximum  of  prism  under  repression,  and  turning 
the  eye  toward  the  short  muscle,  we  enable  it  to 
assume  some  normal  action.  It  also  begins  to 
shorten.  Before  operating  it  is  best  to  wait,  if 
time  is  at  our  disposal,  until  the  muscles  have 
correlated  themselves  to  this  new  position.  Then 
a  tenotomy  has  less  tendency  to  turn  the  eye  in 
the  opposite  direction  and  create  diplopia.  The 
ultimate  outcome  of  immediate  tenotomy  that 
creates  double  vision,  and  of  tenotomy  after  a 
new  correlation  has  been  established,  will  be  the 
same;  but  in  the  latter  case  the  inconvenience  to 
the  patient  would  be  less  immediately  after  the 
operation.  In  the  case  of  the  lateral  muscles, 
complete  tenotomy  is  not  advisable  if  repression 
development  has  not  reached  I  5  deg.  or  upwards, 
and  in  the  case  of  the  vertical  muscles  it  should 
have  reached  12  deo-,  or  more.  In  any  deviation 
of  the  axes  amounting  to  less  than  the  above,  my 
advancement  operation  with  a  ligature  plate  will 
bring  about  the  small  change  of  position  needed 
with  much  more  precision  than  tenotomy.  Even 
in  higher  amounts  of  deviation,  advancement  WMth 
the  ligature  plate  will  fulfill  the  normal  conditions 
in    some    cases    more    perfectly    than    tenotomy. 


RELATION  TO  HEALTH.  187 

especially  in  eyes  that  are  large,  prominent,  and 
apparently  very  loose  in  their  capsules. 

In  developing  a  short  muscle  by  repression,  it 
is  safe  to  conclude  that,  if  we  force  it  to  its 
highest  point  for  several  months,  we  shall  not  be 
able  to  develop  the  muscle  even  then  to  as  short 
or  as  near  a  normal  condition  as  it  would  have  been 
in  had  it  not  been  stretched  for  thirty  years  or 
more.  Just  how  much  the  short  muscle  has  been 
lengthened  and  the  long  muscle  shortened,  during 
this  long  period  of  stretching,  it  is  not  possible 
to  determine  at  once;  but  it  is  absolutely  safe  to 
conclude  that  in  keeping  the  eye  turned  toward 
the  short  muscle  as  far  as  we  can  for  a  few  months, 
we  shall  not  stretch  the  long  muscle  as  much  as 
the  short  one  has  been  stretched. 

When  guided  by  symptoms  and  certain  that 
we  are  right,  we  need  have  no  fear  of  going  too 
far  with  our  repression,  if  it  be  continued  for 
many  months.  Where  from  the  time  of  birth  the 
short  muscle  has  been  constantly  stretched  for 
thirty  years,  it  will  probably  never  be  possible  in 
the  lifetime  of  the  patient  to  make  the  muscle  as 
perfect  by  repression  as  it  would  have  been  had 
it  not  been  too  short  at  the  beginning.  In  the 
course  of  a  few  weeks,  I  have  often  discovered 
more  than  50  deg.  of  latent  defect,  where  none, 
or  at  most  2  deg.  or  3  deg.   was  at  first  manifest 


l88  THE  EYE  IN  ITS 

by  all  diffusion  tests.  The  method  of  merely 
balancing  such  manifest  defects  with  prisms  and 
operations  can  afford  only  temporary  relief,  and  a 
small  amount  even  of  that.  In  a  short  time  after 
all  such  corrections,  a  little  more  of  the  latent 
defect  manifests  itself,  requiring  still  further  cor- 
rection, and  it  continues  to  develop  itself  after 
each  correction  again  and  again  through  a  long 
period  of  time;  on  the  other  hand,  repression 
enables  us  to  arrive  at  the  desired  end  as  quickly 
as  possible,  and  perhaps  lengthen,  by  many  years, 
a  life  that  would  not  have  lasted  through  the 
slower  process.  In  those  cases  where  the  most 
marked  relief  has  followed  tenotomies  that 
brought  about  an  immediate  balance,  I  conceive 
that  the  eye  has  moved  several  degrees  farther 
than  the  manifest  deviation,  but  still  just  within 
the  broad  limit  of  the  verticalizing  andhorizontaliz- 
ing  function  exerted  under  diffusion  tests. 


RELATION  TO  HEALTH.  189 


XIV. 

THIS  work  is  entirely  confined  to  latent  eye 
defects  and  the  repression  of  abnormal  nerve- 
impulse,  and  in  no  way  is  it  intended  as  a  text 
book  on  refraction  or  ocular  surgery.  Only  one 
operation  is  set  forth,  because  it  is  new.  I  think 
it  offers  many  advantages  over  all  others  for  the 
advancement  of  the  recti.  In  all  advancement 
operations  the  tying  of  the  ligature  is  a  question 
of  judgment,  and  at  the  best  we  can  only  approxi- 
mate the  required  change  of  position.  By  such 
operations  we  can  never  hope  to  obtain  anything 
like  absolute  accuracy  in  the  change  of  the 
position  of  the  eye,  for  the  small  difference  of 
one  millimetre  may  mean  several  degrees  of 
deviation  of  the  optic  axes  in  one  direction  or  the 
other.  By  my  operation  with  the  ligature  plate, 
the  desired  position  of  the  eye  will  be  attained 
with  much  greater  accuracy. 

The  ligature  plates  are  made  of  aluminum. 
They  are  about  three  millimetres  in  width,  vary 
in  length  from  about  four  millimetres  to  twelve 
or  more,  and  weigh  from  one-eighth  to  three- 
fourths  of  a  grain.  They  are  spherically  curved 
so  as  to  fit  the   contour  of  the  eye,  their  curva- 


190  THE  EYE  IN  ITS 

tures  being  in  varying  diameters  to  meet  the 
requirements  of  different  sizes  of  eyes.  The 
plate  is  slightly  notched  at  each  end,  with  a 
groove  running  from  each  notch  its  entire  length 
on  the  convex  surface,  into  which  the  ligature  falls 
and  is  out  of  the  way  of  producing  any  irritation. 
An  incision  is  made  through  the  conjunctiva 
and  capsule  of  tenon  in  the  direction  of  the 
muscle,  and  extending  along  its  middle  line, 
beginning  at  its  scleral  attachment  and  extend- 
ing as  far  as  may  be  necessary.  The  muscle 
should  then  be  entirely  freed  from  its  capsular 
and  ocular  attachments.  A  Stevens'  hook  is 
then  passed  behind  the  muscle  and  traction  made 
toward  the  cornea;  another  hook  is  now  passed 
behind  the  muscle  from  its  opposite  side  and 
traction  made  in  the  opposite  direction  at  the 
same  time.  The  point  of  the  second  hook  should 
be  forced  outside  of  the  capsule  so  as  to  expose 
the  muscle  to  view;  a  small  curved  needle  carry- 
ing one  end  of  a  ligature  is  made  to  enter  one 
margin  of  the  muscle  as  far  back  from  its  scleral 
attachment  as  is  necessary,  pass,  as  nearly  as  pos- 
sible, transversely  through  its  fibres,  and  come  out 
on  its  opposite  margin.  This  engages  many  more 
fibres  of  the  muscle  than  the  passing  of  the  liga- 
ture directly  through  it.  It  also  offers  a  much 
greater  support  to  the  ligature,  there  being  much 
less  likelihood  of  its  tearing  away;  in  fact,  it  never 


RELATION  TO  HEALTH.  191 

has  torn  away  in  my  experience.  After  the 
ligature  has  been  so  far  placed,  a  portion  of  the 
muscle  can  be  cut  away  if  it  is  deemed  advisable. 
Unless  the  amount  of  advancement  be  very  con- 
siderable, more  than  six  millimetres,  or  one-fourth 
of  an  inch,  the  operation  will  generally  prove 
fully  as  satisfactory  without  cutting  the  muscle. 
Each  end  of  the  ligature  on  its  respective  side  is 
passed  from  the  under  side  through  the  margin 
of  the  muscle  close  to  its  scleral  attachment. 
After  the  two  ends  of  the  ligature  have  been 
brought  through  these  parts  of  the  muscle,  the 
hooks  are  taken  out.  Each  end  of  the  ligature  on 
its  respective  side  is  now  brought  through  the  con- 
junctiva from  its  under  side,  at  a  point  about  three 
millimetres  in  the  direction  of  the  cornea,  from 
the  scleral  attachment  of  the  muscle  and  about 
eight  or  ten  millimetres  apart,  which  the  width  of 
the  scleral  attachment  should  determine.  The 
exits  through  the  conjunctiva  should  be  from 
three  to  four  millimetres  wider  apart  than  the 
width  of  the  scleral  attachment.  The  two  ends 
of  the  ligature  should  now  be  carefully  tied  by 
a  surgeon's  knot,  not  drawing  the  ligature  so 
tight  as  to  draw  or  pucker  up  very  much  the  con- 
junctiva that  it  engages.  Not  much  drawing  for- 
ward of  the  muscle  should  be  attempted  in  the 
first  tying  of  the  ligature,  it  should  be  just 
tight  enough  to  insure  the  taking  up  of  all  slack 


192  THE  EYE  IN  ITS 

in  the  ligature.  Or,  where  the  conjunctival 
exits  of  the  ligature  were  about  eight  millimetres 
apart,  the  tightening  should  be  sufficient  to  draw 
them  within  about  four  millimetres  of  each  other. 
The  knot  should  be  very  carefully  and  firmly  tied. 
Two  strabismus  hooks  may  now  be  used  or  a 
ligature  dilator  made  for  the  purpose,  and  the 
muscle  may  now  be  advanced  by  traction  in 
opposite  directions.  By  this  process  the  operator 
can  now  see  about  what  length  of  a  ligature  plate 
should  be  used ;  accordingly  he  firmly  seizes  the 
plate  with  a  pair  of  forceps  made  for  the  purpose, 
and  makes  one  of  its  notched  ends  to  engage  one 
side  of  the  ligature.  A  somewhat  strong  Stevens' 
strabismus  hook  is  now  used  to  make  traction  on 
the  opposite  side  of  the  ligature,  and  to  slip  it 
over  into  the  notch  on  the  other  end  of  the  liga- 
ture plate.  The  forceps  and  hook  are  now 
removed  and  the  ligature  and  knot  fall  into  the 
groove  on  the  ligature  plate,  so  that  there  is  no 
possibility  of  its  coming  in  contact  with  the  con- 
junctiva and  giving  rise  to  even  that  amount  of 
irritation  that  an  ordinary  ligature  does. 

An  examination  can  now  be  made  to  ascertain 
the  exact  position  of  the  eye  and  the  amount  of 
advancement  that  has  been  accomplished.  If  it 
is  not  sufficient,  a  ligature  plate  of  greater  length 
can  be  made  to  replace  the  first.  If  too  much 
advancement  has  been  made,  a  shorter   ligature 


RELATION  TO  HEALTH.  193 

plate  can  be  used.  The  ligature  plate  of  a  proper 
shape  and  carefully  made  never  gives  rise  to  the 
slightest  irritation ;  its  presence  is  not  even  felt 
by  the  wearer.  It  should  be  left  in  for  three  or 
four  days. 

When  the  operation  is  made  without  cutting 
the  tendon,  the  muscle  is  tucked  or  folded  upon 
itself,  and  the  inflammatory  action  that  follows 
fastens  it  in  this  position.  The  slight  bunching 
or  enlargement  that  results  from  the  folding 
soon  entirely  disappears  by  absorption.  After 
that  stage  of  the  operation  where  the  ligature  has 
been  passed  through  the  muscle  the  first  time,  a 
portion  of  the  muscle  can  be  cut  away  if  it  is 
deemed  advisable.  Unless  the  amount  of  ad- 
vancement is  very  considerable,  the  operation 
will  generally  prove  fully  as  satisfactory  without 
cutting  the  muscle.  By  this  operation  I  have 
changed  the  position  of  the  eye  30  deg.  without 
cutting  the  muscle. 

Modifications  of  the  above  operation  can  be 
advantageously  made  in  which  this  plate  is  still 
very  useful.  Where  the  conjunctiva  is  sufficiently 
strong  to  withstand  the  necessary  traction,  that 
stage  of  the  operation  where  the  ligatures  are 
passed  through  the  muscle  at  its  scleral  attach- 
ment, may  be  left  out,  so  that,  after  the  ligature 
has  been  passed  through  the  muscle  far  enough 
back,  the  two  ends  may  be  brought  out  through  the 


194  THE  EYE  IN  ITS 

conjunctiva  on  their  respective  sides,  eight  or  ten 
millimetres  apart,  as  close  to  the  cornea  as  possi- 
ble. If  the  conjunctiva  is  sufficiently  strong  to 
stand  the  dragging,  the  ligature  plate  prevents  it 
from  puckering  up,  and  offers  the  advantage  of 
increasing  or  lessening  the  effects  of  our  opera- 
tion, at  the  same  time  hiding  the  ligature  from 
any  touch  with  the  palpebral  conjunctiva.  In  all 
the  old  operations,  after  the  ligature  has  been 
tied,  if  the  position  of  the  eye  is  not  satisfactory, 
any  alteration  involves  a  new  ligature  and  another 
operation ;  whereas  with  the  ligature  plate  these 
alterations  can  be  made  by  substituting  plates  of 
different  lengths. 


RELATION  TO  HEALTH.  195 


XV. 


IN  refutation  of  the  possible  claim  that  the 
results  in  the  foregoing  clinics  are  due  to 
"suggestion,"  I  deem  it  advisable  before  conclud- 
ing this  work  to  say  something  on  the  subject  of 
hypnotism,  although  it  is  a  digression  from  the 
subject  under  consideration.  I  do  not  propose  to 
enter  any  denial  as  to  the  remarkable  phenomena 
that  are  exhibited  in  various  hypnotized  subjects. 
These  are  established  and  undeniable  facts.  The 
entire  investigation  of  the  subject  of  hypnotism 
has  been  confined  to  a  study  of  its  effects  on 
the  hypnotic  subject.  Prevailing  through  all  of 
this  has  been  the  general  superstitious  idea  that 
some  mysterious  force  passed  from  the  operator 
to  the  person  operated  upon,  or  from  the  stronger 
to  the  weaker  mind;  while  there  has  been  little  or 
no  effort  in  the  direction  of  determining  what  the 
actual  physical  causes  were  that  brought  about 
these  results.  The  easiest  subject  for  hypnotism 
is  the  neurasthenic,  whose  general  supply  of  vital 
force  for  various  functions  is  very  limited.  Like 
a  dynamo,  the  nerve-centers  are  capable  of  gen- 
erating a  given  amount  of  vital  force.  In  persons 
suffering   from   nervous    debility,    the    supply  of 


196  THE  EYE  IN  ITS 

nerve-force  is  restricted  and  is  not  sufficient  to 
carry  on  with  vigor  the  various  functions  through- 
out the  animal  economy.  We  must  remember 
that  thought  or  ideation,  of  whatever  nature  it 
may  be,  is  a  process  that  requires  nerve-impulse 
for  its  performance ;  also,  that  a  pain  consists  of 
an  abnormal  nerve  impulse. 

"Suggestion"  that  gives  rise  to  the  so-called 
hypnotic,  psychologic  or  mesmeric  condition  may 
act  through  the  medium  of  any  one  or  more  of 
the  five  senses. 

If  a  person  in  possession  of  a  valuable  treasure 
were  to  enter  at  night  an  isolated  house  which  he 
had  every  reason  to  believe  was  unoccupied  by 
any  other  person,  and  while  slowly  feeling  his 
way  in  the  dark,  from  room  to  room,  should  sud- 
denly feel  a  hand  placed  on  his  shoulder,  a  radi- 
cal change  would  at  once  take  place  in  his 
nerve-centers,  and  such  a  change  would  be 
greater  or  less  according  to  his  condition  and 
surroundings. 

If  a  person  who  was  familiar  with  the  taste  of 
various  poisons  were  to  enter  a  dimly  lighted 
apothecary  shop  and  carelessly  swallow  a  dose  of 
something  supposed  to  be  a  sweet  cough  mixture, 
and  the  dose  suddenly  proved  to  be  intensely 
bitter,  he  might  at  the  time  think  he  had  taken  a 
dose  of  strychnine,  and  a  change  in  the  action  of 
the  nerve-centers  would  take  place,  commensurate 


RELATION  TO  HEALTH.  197 

with  the  condition  of  the  person  and  his  sur- 
roundings. I  have  known  such  an  accident  to 
produce  complete  prostration;  but  when  it  was 
learned  that  the  bitter  dose  was  quinine,  the  re- 
covery was  rapid. 

The  smell  of  smoke  in  a  high  building  with 
insufficient  means  of  egress  might  suggest  the 
idea  of  a  horrible  death  by  fire,  and  varying  con- 
ditions would  result  in  the  nervous  systems  of  the 
persons  so  frightened. 

Through  the  medium  of  the  sense  of  hearing 
very  potent  changes  in  the  nervous  system  are 
brought  about.  One  Sabbath  morning  many 
years  ago  I  was  sitting  on  the  veranda  of  a  hotel 
in  the  South,  when  suddenly  I  heard  a  most  ter- 
rific and  unnatural  sound,  the  building  trembled 
violently,  the  air  seemed  dense  and  oppressive. 
For  the  moment  I  was  helpless,  I  could  not  think, 
I  could  not  move  ;  the  horrible,  weird  strangeness 
of  the  sound  had  suspended  my  functions  of 
volition  and  reason.  The  time  was  but  a 
moment,  but  it  seemed  many  to  me ;  then  I  saw 
falling  by  me  to  the  ground  the  mutilated  form 
of  a  man.  This  recalled  me  somewhat  to  my 
senses.     There  had  been  an  explosion. 

Remarkable  changes  are  aroused  in  the  nerve- 
centers  through  the  medium  of  vision ;  intense 
feelings  of  pleasure,  pain  or  fear  are  induced  by 


19S  THE  EYE  IN  ITS 

"suggestion"  through  this  medium.  The  lover 
of  nature  is  hypnotized  as  he  looks  upon  some 
strangely  grand  or  beautiful  scene  ;  "suggestion" 
from  the  inanimate  surroundings  has  influenced 
the  action  of  his  nerve-centers. 

Complete  prostration  and  often  unconscious- 
ness are  induced  by  something  that  is  seen.  The 
changes  that  are  wrought  in  the  nervous  system 
by  the  strange  and  fantastic  "passes"  or  "move- 
ments" that  are  made  by  the  so-called  mesmerist, 
hypnotist  or  psychologist  are  no  more  due  to  a 
force  or  entity  that  passes  from  the  operator  to 
the  subject,  or  from  the  stronger  to  the  weaker 
mind,  than  the  similar  mental  conditions  men- 
tioned above  are  due  to  the  transference  of  a 
similar  entity  or  force.  Inasmuch  as  similar 
effects  are  brought  about  by  inanimate  surround- 
ings, it  is  evident  that  there  need  be  no  transmis- 
sion of  a  force  to  produce  the  hypnotic  state. 
The  interesting  and  amusing  phenomena  that  are 
brought  about  by  "suggestion"  are  commensurate 
with  the  weakness  or  excitability  of  the  nervous 
system  of  the  subject. 

After  the  "suggestion"  all  the  changes  or 
phenomena  that  take  place  in  the  subject  are  due 
to  the  action  of  forces  in  his  nerve-centers.  A 
belief  that  there  is  some  mysterious  force  sent 
out  by  the  operator  or  the  stronger  mind  is  very 


RELATION  TO  HEALTH,  199 

foolish  and  dangerous,  for  persons  so  believing 
are  easy  subjects,  and  become  victims  of  persons 
of  evil  design. 

When  the  imagination  is  sufficiently  excited 
by  "suggestion"  there  is  so  excessive  a  call  upon 
the  nerve-centers  for  vital  force  to  sustain  the 
exalted  ideation,  that  all  other  functions  for  the 
time  being  are  robbed  of  the  limited  vital  impulse 
with  which  they  were  previously  supplied.  The 
nerve-impulses  that  gave  rise  to  the  functions  of 
feeling,  motion  and  reason  are  perverted ;  and 
where  pain  existed  the  abnormal  impulse  that 
gave  rise  to  it  has  been  turned  aside  and  utilized 
in  the  strong  imagination  that  has  been  awakened. 
The  subject  is  utilizing  all  his  feeble  vital  forces 
to  maintain  an  excited  mental  condition  that  has 
been  aroused  by  "suggestion,"  which  may  be  by 
the  word  of  mouth,  motion,  general  surroundings 
or  exciting  events.  Where  pain  is  relieved  by 
hypnotism,  it  is  because  the  impulse  that  gave 
rise  to  it  has  been  perverted  into  this  new  channel. 
Where  the  function  of  feeling  is  suspended,  it  is 
because  the  vital  forces  have  been  so  drawn  upon 
that  there  is  not  sufficient  left  to  give  rise  to  the 
function  of  feeling.  Where  the  reasoning  fac- 
ulties are  so  perverted  that  one  can  be  made  to 
believe  and  apparently  see  things  as  they  are  not, 
it  is  because  the  excitation  has  so  utilized  the 
vital    forces    that    there   is   not  sufficient   left  to 


200  THE  EYE  IN  ITS 

assert  reason,  and  whatever  is  suggested  is  ac- 
cepted as  truth.  Hypnotism  or  "suggestion"  is 
the  diversion  into  other  channels  of  those  nerve- 
impulses  that  give  rise  to  feeling,  motion  or 
reason,  the  turning  of  them  aside  from  the  per- 
formance of  normal  functions  to  execute  another 
kind  of  work. 

It  is  on  this  principle  that  a  mustard  plaster 
or  any  other  counter  irritant  acts :  it  turns  aside 
the  nerve-impulses  that  gave  rise  to  pain  and 
utilizes  them  in  the  secondary  or  induced  irri- 
tation. 

"  Some  ideas  are  suggested  to  the  mind  by  all 
the  ways  of  sensation  and  reflection." — (Locke.) 

"  Suggest :  To  introduce  indirectly  to  the 
thoughts ;  to  cause  to  be  thought  of,  usually  by 
the  agency  of  other  objects." — (Webster.) 

When  a  person  steps  upon  a  tack  it  suggests 
thoughts  and  sometimes  words  that  are  very  em- 
phatic ;  the  savory  smell  of  a  broiling  mutton 
chop  will  often  suggest  hunger  ;  the  whistle  of 
a  locomotive  suggests  that  more  haste  will  have 
to  be  made  or  the  train  may  be  missed ;  whenever 
I  hear  a  certain  piece  of  music  it  always  suggests 
to  me  the  lovely  Jepsom  Gardens  and  the  Holly 
Walk  at  Leamington  on  the  river  Leam,  for  it 
was  there  that  I  first  heard  this  music ;  the  taste 
of  some  delicious  viand  often  suggests  some  other 
time   and    scene   where    this    flavor  awakened  a 


RELATION  TO  HEALTH.  201 

more  than  ordinary  degree  of  pleasure  ;  seeing 
another  put  on  his  gloves  and  hat  might  suggest 
to  a  man  that  it  was  time  to  go  home.  "Sug- 
gestion" in  its  fullest  sense  is  susceptible  of  a 
very  broad  definition. 

"•  Hypnotism,"  a  word  of  Greek  derivation, 
and  meaning  sleep,  is  at  present  used  in  almost 
as  broad  a  sense  as  the  word  "suggestion,"  and 
many  of  the  mental  states  that  result  from  •*  sug- 
gestion "  are  denominated  "hypnotic."  The 
average  mind  is  quite  as  open  to  "suggestion"  in 
the  present  day  as  it  has  been  in  all  ages  past. 
It  is  not  capable  of  reasoning  for  itself.  It  gen- 
erally follows  out  certain  lines  of  action  because 
they  are  conventional  or  have  been  "suggested" 
by  others.  A  collegiate  training  is  valuable  to 
those  minds  that  are  capable  of  receiving  it,  for 
it  imbues  them  with  formulated  methods  of 
analysis  and  action,  which  methods  are  the  pro- 
ducts of  reasoning  minds  that  have  thought  for 
the  benefit  of  others.  What  is  called  original 
thought  comes  to  but  few.  "The  power  of  step- 
ping out  of  the  beaten  track  of  thought,  of 
bursting  by  a  happy  inspiration  through  the 
bonds  of  habit  and  originating  a  new  line  of  re- 
flections, is  most  rare,  and  should  be  welcomed 
in  spite  of  its  sometimes  becoming  extravagant." 

At  present  the  people  in  several  sections  of 
our   great    republic    are    running   wild    over    the 


202  THE  EYE  IN  ITS 

question  of  hypnotism.  Many  of  these  unthink- 
ing minds  have  been  led  to  believe  that  when- 
ever a  buffoon  raises  his  hands  and  makes 
certain  meaningless  motions,  they  are  bound  to 
become  helpless  and  follow  whatever  suggestions 
he  may  make.  Excessive  fear  and  awe  are  the 
results  of  this  belief,  and  an  exalted  excitation  of 
the  nerve-centers  results,  which  may  actually  pro- 
duce what  is  called  the  "hypnotic"  state;  but 
where  this  belief  does  not  exist,  and  where  there 
is  an  unbelief  as  to  this  mysterious  force,  however 
weak  the  subject  may  be,  these  methods  fail  to 
hypnotize. 

I  remember  a  mesmerist  who  several  years  ago 
was  lecturing  in  a  small  town  in  Ohio.  He  had 
succeeded  in  exciting  quite  a  large  number  of  the 
community.  The  audiences  of  his  nightly  lectures 
grew  until  the  opera  house  would  barely  hold 
them.  He  was  very  much  reassured  by  his  success 
and  invited  the  opinion  of  any  member  of  his 
audience.  A  professional  gentleman  walked  to 
the  rostrum  and  set  forth,  in  a  very  clear  and  con- 
cise manner,  opinions  similar  to  those  given  in 
this  chapter.  From  that  time  his  so-called  hyp- 
notic power  ceased,  and  of  the  ten  subjects  on  the 
stage  who  had  been  obeying  his  suggestions,  there 
were  but  two  who  continued  to  do  so.  These 
were  strangers  to  the  community,  and  I  afterwards 
learned   from   one   of  them  that  they  were  both 


RELATION  TO  HEALTH.  203 

under  his  pay  at  a  salary  of  ^15  per  week.  It  is 
not  necessary  for  a  hypnotist  to  resort  to  this 
trickery,  for  if  a  firm  belief  in  the  mysterious  force 
exists  in  a  person  with  a  weak  nervous  system,  he 
can  undoubtedly  be  hypnotized.  It  is  now  high 
time  for  thinking  professional  men  to  come  to  the 
assistance  of  the  unthinking  masses,  and  teach 
them  that  it  is  as  unnecessary  to  yield  up  reason 
and  thought  to  the  gyration  of  the  hypnotist's 
arms  as  to  the  whirling  of  a  merry-go-round. 

Horses  are  almost  universally  hypnotized  when 
a  barn  takes  fire.  Invariably  they  refuse  to  leave 
their  stable.  It  has  always  been  their  place  for 
feed,  drink  and  rest.  In  their  thoughts  it  is  most 
safe  and  comfortable  of  all.  Under  the  exalted 
excitement  of  the  nerve-centers  of  the  animal,  all 
other  instincts  vanish. 

I  have  a  number  of  chickens  which  were 
hatched  last  spring  and  had  never  seen  the  snow 
until  this  winter.  On  a  Friday  evening  one 
perched  itself  on  an  elevated  portion  of  the  hen 
house.  During  the  night  a  heavy  snow  fell.  On 
the  following  Tuesday  evening  my  neighbor  came 
in  to  tell  me  that  there  was  a  hen  standing  on  top 
of  my  hen  house  and  that  it  had  been  standing 
there  for  four  days.  At  least,  every  time  any- 
body looked  out  of  the  window,  the  hen  was  seen 
standing  in  the  same  position,  and  it  was  inferred 
that  she  must  have  been  standing  there  all  that 


204  THE  EYE  IN  ITS 

time.  I  became  interested,  at  once  went  into  the 
back  yard,  crawled  on  to  the  roof,  and  approached 
the  hen.  She  paid  not  the  slightest  attention  to 
my  presence ;  she  seemed  perfectly  unconscious 
of  all  surroundings.  As  I  stretched  my  hands 
toward  her,  she  did  not  move,  but  after  I  seized 
hef,  she  at  once  began  to  squawk. 

In  looking  from  a  high  tower  or  precipice  some 
people  experience  a  feeling  allied  to  hypnotism. 
Wonder,  awe  and  fear  so  utilize  the  vital  forces 
that  reasoning  and  self-control  are  temporarily 
gone.  The  many  so-called  suicides  committed 
by  jumping  into  Niagara  Falls  or  from  high  towers, 
are  acts  committed  in  the  hypnotic  state  ;  at  least, 
I  believe  a  great  mistake  is  made  in  indiscrimi- 
nately calling  such  acts  suicide.  It  is  a  notable 
fact  that  all  high  towers  have  to  be  protected 
so  that  people  cannot  jump  from  them.  The 
Washington  Tower,  the  London  Monument,  the 
Eiffel  Tower,  the  dome  at  the  Capitol  of  Wash- 
ington and  many  others  have  had  wire  network  or 
other  apparatus  put  up  to  prevent  persons  from 
jumping  from  them.  I  think  it  is  a  grave  injus- 
tice to  call  all  such  acts  suicide. 

It  is  perhaps  a  mistake  to  allow  the  word  hyp- 
notism to  assume  as  broad  an  application  as  is  now 
popular.  In  this  sense  every  speaker,  every 
preacher  is  a  hypnotist.  Each  suggests  his  good 
thoughts   from    the    pulpit    or    the    rostrum    and 


RELATION  TO  HEALTH.  205 

endeavors  thereby  to  influence  his  hearers.  The 
successful  jurist  by  rhetoric,  oratory,  earnestness 
and  gestures,  hypnotizes  the  jurymen  until  tears 
mark  the  result.  Every  business  man,  every 
solicitor  utilizes,  to  his  utmost,  his  power  of  sug- 
gestion, for  the  sake  of  influencing  his  customers. 

What  I  wish  particularly  to  point  out  in  this 
chapter  is  that  there  need  be  no  transference  of  a 
mysterious  force  from  the  operator  to  the  subject 
to  bring  on  hypnotic  states,  inasmuch  as  inanimate 
surroundings  can  produce  a  similar  effect. 

Considered  in  the  line  of  the  above  hypothesis, 
the  changes  that  take  place  in  so-called  "faith 
cures"  are  easily  accounted  for.  It  is  probably  a 
fact  that  many  deranged  functions  have  been 
restored  to  more  normal  action  through  an  effect 
on  the  nerve-centers  brought  about  by  "  sugges- 
tion "  in  the  form  of  Christian  Science,  hypnotism, 
or  faith  cure.  We  are  fully  aware  that  fright  is 
often  the  exciting  cause  of  deranging  the  nerve- 
centers  to  the  extent  of  disturbing  some  important 
function.  Fright  has  also  been  known  to  restore 
to  normal  action  a  disturbed  function.  In 
aphonia,  which  is  of  frequent  occurrence  in  cer- 
tain individuals  suffering  from  nervous  debility, 
the  power  of  speech  has  often  been  restored  by 
some  person  approaching  the  patient  unobserved, 
suddenly  making  a  loud  sound  close  to  the  ear, 
and  so  causing  fright. 


2o6  THE  EYE  IN  ITS 

This  switching  or  transference  of  nerve- 
impulse  may  possess  some  value  in  scientific 
hands,  but  in  no  way  does  it  fulfill  the  require- 
ments of  enfeebled  or  insufficient  nerve-centers. 
The  true  end  to  be  sought  is  vigor  and  equilib- 
rium of  action  in  all  the  nerve-centers,  so  that  all 
functions  may  receive  a  normal  share  of  nerve- 
impulse  for  their  performance;  a  result  which  is 
hardly  to  be  expected  from  suggestion  or  faith 
alone.  A  fair  average  of  success  in  this  direction 
is  illustrated  in  Walter  Scott's  "Waverley,"  where 
the  Scotchman  tried  to  teach  his  mule  to  do 
without  food.  He  gradually  reduced  the  poor 
animal's  feed  until  he  ate  but  one  straw  a  dav, 
when  he  died. 

Again  I  repeat,  hypnotism  or  "  suggestion  "  is 
the  diversion  into  other  channels  of  those  impulses 
that  give  rise  to  feeling,  motion  and  reason;  it  is 
the  turning  of  them  aside  from  the  performance 
of  their  normal  functions  to  execute  another  kind 
of  work. 

That  the  favorable  results  brought  about  by 
repression  are  not  due  to  "  suggestion  "  is  evident 
from  the  following  illustration.  A  person  requir- 
ing a  prism  in  a  certain  position  for  repression  is 
materially  relieved  while  the  prism  is  in  the 
proper  position.  If,  without  the  knowledge  of  the 
patient,  the  prism  be  reversed,  all  the  unfavorable 
symptoms   will   be  materially  aggravated,    while 


RELATION  TO  HEALTH.  207 

the  "  suggestion  "  to  the  patient  is  the  same  with 
the  prism  in  one  position  as  the  other.  Such 
tests  can  be  repeatedly  made  on  patients  under 
repression,  and  the  results  are  uniformly  the  same. 
The  proper  position  of  the  prism  always  relieves, 
and  the  reverse  always  aggravates  the  symptoms; 
consequently  "suggestion"  is  not  the  source  of 
the  relief.  Adverse  **  suggestion  "  and  ridicule  from 
those  unfamiliar  with  the  philosophy  of  this  sub- 
ject have  exerted  their  fullest  influence  in  dis- 
couraging patients  and  counteracting  the  favorable 
results.  I  believe  and  do  not  hesitate  to  say  that 
many  people  have  sacrificed  their  lives  through 
following  the  advice  of  persons  who  were  ignorant 
of  the  science  of  the  subject.  It  is  always  unwise 
to  give  advice  without  first  possessing  the  neces- 
sary information.  We  should  never  accept  and 
act  upon  advice  until  we  have  settled  in  our  mind 
the  qualifications  of  the  person  giving  it.  Has 
he  grounds  for  his  claim  to  a  superior  knowledge 
of  the  matters  on  which  he  advises? 

When  the  philosophy  set  forth  in  this  work  is 
more  generally  understood,  it  is  certain  to  be 
generally  practiced,  and  its  benefits  will  be  shared 
by  many  sufferers.  For  his  years  of  labor,  the 
author  deems  himself  well  rewarded  by  the  results 
already  obtained,  although  he  looks  upon  these 
results  only  as  the  earnest  of  greater  things  to 
come. 


GLOSSARY. 


Abnormal  Innervation:  An  excess  or  insufficient  supply 
of  nerve-impulse. 

Afferent  Nerve -impulse  :  An  impulse  conveyed  from 
without  to  the  nerve-centers. 

Brain  -  leak  :    A  waste  of  nerve-force. 

Degree  :  An  angle  equivalent  to  ^^  part  of  a  circle. 
The  prism  degree  mentioned  in  this  book  is  equivalent 
to  about  a  half  degree  in  trigonometry. 

Differential  Test:  A  test  for  determining  the  ability 
of  the  eyes  to  fuse  in  opposition  to  prisms  in  different 
positions.  For  instance,  base  down  before  one  eye  and 
then  the  other,  or  up  before  one  eye  and  then  the  other, 
noting  the  difference  in  the  prism-power  that  can  be 
fused  for  in  these  varying  positions. 

Diffusion  Tests  :  Tests  that  create  double  vision,  either 
by  the  use  of  means  calculated  to  lessen  the  natural 
stimuli  of  the  eyes  or  by  the  use  of  prisms. 

Dynamic  Centers  :  Centers  in  the  nervous  system  where 
nerve-force  is  generated  and  sent  forth  for  the  perform- 
ance of  functions. 

Efferent  Nerve  -  impulse  :  An  impulse  that  is  con- 
veyed from  the  nerve-centers  outward. 

Fogging  :  Dimming  the  vision  and  stimulating  the  ciliary 
muscle  to  relax  its  tonic  spasm,  by  the  application  to 
the  eye  of  a  convex  glass. 

Heterophoria  :  Different  tending  of  the  optic  axes  or 
lines  of  sight. 

ESOPHORIA  :     Inward  tending  of  the  lines  of  sight. 

ExoPHORiA  :    Outward  tending  of  the  lines  of  sight. 

Hyperphoria  :    Upward  tending  of  the  lines  of  sight. 

„  [  :    Downward  tending  of  the  lines  of  sight. 

2og 


2IO  GLOSSARY. 

HORIZONTALIZE  :     To  fix  the  eyes  so  that  the  lines  of  sight 
will  fall  in  a  horizontal  plane. 

Innervation:    The  act  of  furnishing  nerve-force. 

Latent  Eye  -  strain  :  Eye-muscle  defects  that  are  hidden 
and  not  discoverable  by  diffusion  tests. 

Manifest  Eye -strain:  Eye-muscle  defects  which  are 
at  once  discovered  by  diffusion  tests. 

Metastasis  :  The  change  of  a  disease  from  one  part  of 
the  body  to  another. 

Motive -force  :  Nerve-impulse  or  nerve-force,  which  is 
the  dynamic  force  in  the  performance  of  function. 

Mydriatic  :  A  drug  that  dilates  the  pupil  and  relaxes 
the  ciliary  muscle  of  the  eye. 

Neurasthenia  :    An  insufficient  supply  of  nerve-force. 

Neurosthenia  :  An  irritant  or  excessive  supply  of  nerve- 
force. 

Orthophoria  :  Regular  or  correct  tending  of  the  optic 
axes  or  lines  of  sight. 

Paranoia  :     Insanity  in  which  the  acts  are  systematized. 

Polarity  :  The  quality  by  which  a  body  exhibits  the 
power  to  attract  and  repel. 

Repression  :  The  abatement  of  an  excessive  nerve- 
impulse,  accomplished  by  reversing  a  strain. 

Reverse  Manifest  Eye -strain:  A  strain  that  turns 
an  eye  in  the  direction  opposite  to  the  muscle  that  is  too 
short. 

Traumatic  :     Pertaining  to  injuries  or  wounds. 

Verticalize  :  To  fix  the  eyes  so  that  the  lines  of  sight 
will  fall  in  a  vertical  plane. 

Zymotic  :  Pertaining  to  the  deleterious  effects  of  mi- 
crobes, as  in  producing  disease. 


INDEX, 


Abnormal  innervation,  26-27;  causes 
diseases  of  the  eye,  43. 

Accommodation,  broken  down,  142. 

Accommodation,  153. 

Action  of  medicines,  ;6. 

Advancement  of  the  ocular  mus- 
cles a  new  operation,  189. 

Advance  medical  science,  8. 

Alcoholism,  cure  for,  49-53. 

Alterations  of  function  are  all  pri- 
marily central  in  the  nervous  sys- 
tem, 19. 

Anatomical  location  of  nerve-cen- 
ters, 20-21,  33. 

Apparent  defects,  177-178. 

Art  gallery  and  sight  seeing  ex- 
cites the  nerve-centers.  24. 

Assimilation,  19-20. 

Asthma,  48. 

Astigmatism,  I5i-i!;2. 

Atom  of  the  body,  every,  has  some 
office,  17-19- 

Atrophy  of  the  optic  nerves  and 
general  debility.   Case  XVI,  113. 

Before  operating,  182. 

Belief  in  long  established  theories 

quite  natural,  16. 
Blood  simply  a  carrier,  20. 
Bronchitis,    chronic.     Case    XIV, 

109. 

Cataphoria   and  hyperphoria,  i78. 

Cataract,  43. 

Catarrh,  48,  59. 

Cathartic  a,  acts  on  the  nerve 
centers,  61-62. 

Caution  in  testing,  135-136. 

Ciliary  muscle,  137. 

Constipation  a  nerve-center  de- 
rangement, ( I. 


Consumption,   64.     Case  X,  104; 

case  XI,  105;  case  XII,  107;  case 

XIV,  iio-iii. 
Correction    of    manifest     defects 

gives  only  temporary  relief,  185- 

188. 
Correlation,  153-154. 
Critic,  a,  7. 

Danger  lies  in  the  eyes  remaining 
in  that  abnormally  balanced  con- 
dition that  is  threatening  life. 
Case  IV,  95. 

Deafness,  ovaritis  and  general  de- 
bility.   Case  XX,  125. 

Defect  in  one  muscle  sometimes 
hides  defects  in  others,  99. 

Diabetes,  47.  Case  V,  95;  case 
VII,  98;  case  XVII,  114. 

Development  of  the  ocular  mus- 
cles, 174-176. 

Differential  test,  156-158. 

Diffusion  tests,  167-170. 

Disease,  causes  of,  5,  6S-67;  im- 
munity from,  44-46;  we  do  not 
inherit  disease,  64;  diseases  of 
the  eye  due  to  abnormal  inner- 
vation, 43;  disease  is  localized 
nervous  derangement,  46;  dis- 
ease and  health,  40. 

Distances,  judgment  of,  153-154. 

Double  vision  after  tenotomies, 
185. 

Effect,  every,  has  a  cause,  23,  61. 

Endurance  of  various  nerve-cen- 
ters, 33-34- 

Epilepsy.    Case  VIII,  99. 

Esophoria,  174-177. 

Excitement  emphasizes  functions, 
18. 


211 


212 


INDEX. 


Experience  in  old  methods  of  no 
value  in  formulating  opinions  of 
new  methods,  8. 

Exophoria,  177. 

Eye  muscles,  68;  complex  arrange- 
ment of,  69;  physiology  of  the, 
171.  173;  why  defects  in  the  eye 
muscles  are  so  deeply  hidden, 
75-76;  defects  in  the  eye  muicles 
locked  together,  154-1;;. 

Eye-strain,  evidence  of  the  univer- 
sality of,  70-76,  130. 

Eye-  train,  latent,  often  causes 
nervous  derangement,  43;  repres- 
sive, 132. 

Eye-strain,  manifest,  causes  little 
disturbance,  133-134. 

Eyes  of  new-born  infants,  71. 

Eyes  of  the  dead.  72. 

Eyes  of  the  dipsomaniac  after 
death,  73-74. 

Eyes  that  perform  perfect  vision 
may  have  serious  defects,  70. 

Feeling  is  all  in  the  nerve-cent- 
ers, 55. 

Five  senses,  the,  are  feelings,  33. 

Fogging,  141-142.  also  155-164:  some- 
times induces  sleep,  142-143. 

Function,  every,  is  performed  by 
nerve  or  motive  impulse,  17. 

Function,  normal  or  abnormal,  is 
characterized  by  the  nature  of 
the  nerve-impulse,  21-23, 4;;  func- 
tions are  emphasized  under  ex- 
citement, 18. 

Functional  disturbances,  contin- 
ued, result  in  organic  disease,  55. 

Function,  character  of,  depends 
on  the  character  of  nerve  force 
supply.  21-22. 

Fusion,  35-39;  135- 

Glaucoma,  43. 

Growth  and  formation  of  all  parts 
of  the  body  are  influenced  by  a 
person's  surrounding^s,  2S-34. 

Growth  of  tumors,  41,  55. 

GjTnnastic  exercises  of  the  ocular 
muscles,  131. 


Hay  fever,  48. 

Health  and  disease,  40. 

Health  may  continue  to  improve 
for  years,  7S. 

Health  must  be  carefully  guarded 
when  restored,  78. 

Homoeopathic  principle,  56. 

Horizontalizing  tendency  and  ver- 
ticalizing  tendency.  35-39. 

Hypermetrophia,  manifest  and 
latent,  137-139:  functional  mani- 
fest, 13S;  non- functional  mani- 
fest. 138. 

Hyperphoria  and  cataphoria,  178. 
I  Hypnotic  phenomena,  the  force 
that  produces  the.  195,  207. 

Immunity  from  disease,  44-46. 
Imperfect     structure     co-existent 

with  perfect  vision,  9-14. 
Inflammation,  53. 
Insanity.    Case  XIX,  116. 
Intent  of  this  work,  42. 

Judgment  of  distance.  153-154. 
Just  estimate  can   be  arrived    at 
only  by  perusing  all  the  pages,  8. 

Latent    muscular    defect.     Case 

III,  87. 
Laws  of  refraction  in  an  advanced 

state,  9. 
Lesion,  a.  is  always  a  result  and 

not  a  cause,  41,  60. 

Medicines,  action  of,  56. 

Mental  suggestion    14-1!;,  I95.  207. 

Metastasis,  53-54. 

Microbe  theory,  44-46. 

Motor  ataxy,  65.    Case  VI,  96. 

Muscular  defects,  how  they  mani- 
fest themselves.  Case  I,  79; 
partly  manifest,  case  II,  81; 
latent,  case  III,  87;  manifest 
muscle  defects  more  common  in 
the  lateral  muscles,  167.  178; 
muscle  defects  may  be  entirely 
latent  to  diffusion  tests.  42. 

Muscular  weakness,  129. 


INDEX. 


213 


Mydriatics  — hyoscyamine,  atro- 
pine and  their  congeners,  139. 

Myopia  takes  its  origin  as  hyper- 
metropia,  143-151;  its  probable 
cause  and  how  to  guard  against 
it,  149-151. 

Names  of  diseases,  46-48. 

Negligence,  evidence  of,  102. 

Nerve-center,  each,  is  intimately 
connected  with  all  other  nerve- 
centers,  27. 

Nerve-centers,  20-21;  anatomical 
location  of,  35;  what  part  of  the 
nerve-centers  has  the  greatest  in- 
fluence, 28-29. 

Nerve-centers  compared  with  the 
electric  dynamo,  23. 

Nerve-impulses,  afferent  and  ef- 
ferent, 58,  63-64;  the  prime  mover 
in  all  functions,  42;  obstinacy  of 
established  nerve-impulse,  78. 

Nerves  supplying  the  ocular  mus- 
cles, 171. 

Nerve  transplantation,  63. 

Nerves  are  passive  and  without 
feeling,  48-49. 

Nervous  derangement  often  the 
result  of  eye-strain  that  is  en- 
tirely latent,  43. 

Neurosthenia  and  neurasthenia, 
26. 

New  correlation,  76,  78. 

New  methods  produce  new  re- 
sults, 7. 

Number  of  degrees  of  deviation  in 
the  optic  axes  can  never  deter- 
mine the  amount  of  eye-strain, 
133. 

Obstinacy  of  established  nerve- 
impulse,  78. 

Ocular  muscles,  relative  strength 
of,  129;  advancement  of,  a  new 
operation,  189;  gymnastic  exer- 
cise of  the,  131. 

Offer  of  clinical  demonstrations, 
8-9. 

Optic  axes,  35-39;  why  they  deviate, 
129. 


Organic  disease  the  result  of  con- 
tinued functional  disturbance,  53. 

Organic  products  depend  on  the 
nature  of  the  nerve-impulses,  63. 

Orthophoria,  relative  and  individ- 
ual, 165. 

Ovaritis,  54,  60-61. 

Ovaritis  and  diabetes.  Case  III, 
87;  case  IV,  91. 

Over-develop,  can  we,  a  muscular 
defect,  180. 

Paralysis    and     complete    loss    of 

mind.    Case  XVIII,  115. 
Paralysis,  cure  of.    Case  IX,   102. 
Paresis,  129. 
Part  of  the  body,  every,  is  like  an 

engine,  17-18. 
Perfect  brain,  a,  its  tendency  is  to  a 

perfect  body  and  a  perfect  life,  73. 
Perfect  pair  of  eyes,  not  one  in  a 

hundred,  69-70. 
Perfect   vision  under  serious  eye 

defects,  178-179. 
Positions  of  the  head,  iSi. 
Power  of  the  eye  to  hide  defects, 

74-75. 
Physiology  of  the  eye  muscles,  171, 

173- 

Reflex  and  reflex  diseases,  58-59. 
Relief  of  pain  is  no  evidence  of 

cure,  76-77. 
Repressing  abnormal  innervation 

differs  from    the     correction   of 

muscular  insufficiency,  13. 
Repression,  145,  15S-164. 
Repressive  eye-strain,  132. 
Reverse  manifestation,   12.     Case 

IV.  91. 

Secondary  reflexes,  65. 
Shaking  palsy.    Case  XV.,  112. 
Shortening  of  the  stretched  muscle 

after  operation,  184. 
Sight  awakens  a  feeling  of  all  the 

other  senses,  30-31;  is  an  active 

function  requiring  vital  energy 

or  nerve-force,  24-25. 
Sight,  taste,    smell   and   hearing, 

29-31- 


214 


INDEX. 


Stretched  muscles  are  undevel- 
oped, 153,  1S3-184. 

Suggestive  mental  poison,  207. 

Symptom  tests,  161-162. 

Systemic  depressants  and  stimu- 
lants, their  influence,  139. 

Tabulated  clinics,  126-128. 
Tendency  of  a  perfect  brain  is  to  a 
perfect  body  and  a  perfect  life,  73. 
Too  much  light  is  injurious,  31-32. 
Transplantation  of  nerves,  63. 
Tumors,  growth  of,  41,  55. 


Verticalizing  tendency  and  hori- 
zontalizing  tendency,  35-39. 

Visual  centers,  35-37;  they  are  the 
most  sensitive,  34. 

We  do  not  inherit  disease,  64. 
What  part  of    the    nerve-centers 

has  the  greatest  influence,  28-29. 
Why  defects  in    the    eye-muscles 

are  so  deeply  hidden,   75-76,  80; 

locked  together,  154-155. 
Why  man  and  wife  grow  to  look 

alike,  2S. 


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